20000, General Revenue Services

Revision 20-4; Effective October 15, 2020

General Revenue (GR) funded services are primarily intended to help persons remain in their own home or their family’s home. GR refers to state funds and GR funded services are paid by state funds and not federal funds. Not all GR funded services described in this section are available in all areas of the state. These services are provided by or through a local intellectual and developmental disability authority (LIDDA).

20100 Definitions

Revision 20-4; Effective October 15, 2020

In this section, the following terms are defined as follows:

Behavioral Supports – Specialized interventions by professionals with required credentials to assist a person to increase adaptive behaviors and to replace or modify maladaptive behaviors that prevent or interfere with the person’s inclusion in home and family life or community life. Supports include:

  • assessing and analyzing assessment findings so that an appropriate behavior support plan can be designed;
  • developing an individualized behavior support plan consistent with the outcomes identified in the person-directed plan;
  • training and consulting with family members or other providers and, as appropriate, to the person; and
  • monitoring and evaluating the success of the behavioral support plan and modifying it as necessary.

Community Support – Provides individualized activities for persons that are consistent with the person’s person-directed plan and provided in the person’s home and at community locations, (e.g., libraries and stores). Supports include:

  • habilitation and support activities that foster improvement of, or facilitate, the person’s ability to perform daily living activities;
  • activities for the person’s family that help preserve the family unit and prevent or limit out-of-home placement of the person;
  • transportation for the person between home and his or her community employment site or day habilitation site; and
  • transportation to facilitate the person’s employment opportunities and participation in community activities.

Day Habilitation – Assistance with attaining, retaining or improving self-help, socialization and adaptive skills necessary to live successfully in the community and to participate in home and community life. Individualized activities are consistent with achieving the outcomes identified in the person-directed plan and activities are designed to reinforce therapeutic outcomes targeted by other service components, school or other support providers. Day habilitation is normally furnished in a group setting, other than the person’s residence, for up to six hours a day, five days per week on a regularly scheduled basis. The service includes personal assistance for persons who cannot manage their personal care needs during the day habilitation activity, as well as assistance with medications and the performance of tasks delegated by a registered nurse in accordance with state law.

Eligibility Determination – An interview and assessment, or an endorsement, conducted in accordance with Texas Health and Safety Code, §593.005, and 40 Texas Administrative Code (TAC) Chapter 5, Subchapter D, to determine if a person has an intellectual disability or is a member of the intellectual and developmental disability (IDD) priority population.

Employment Assistance – Assistance to a person in locating paid, individualized competitive employment in the community, including:

  • helping the person identify employment preferences, job skills, work requirements and work conditions; and
  • identify prospective employers offering employment compatible with the person’s identified preferences, skills, and work requirements and conditions.

General Revenue (GR) Funded Services – IDD services funded by GR funding through the performance contract.

Nursing – Provided to people who require treatment and monitoring of health care procedures that are:

  • prescribed by a physician or medical practitioner; or
  • required by standards of professional practice or state law to be performed by licensed nursing personnel.

Respite – Planned or emergency short-term relief services to the person’s unpaid caregiver when the caregiver is temporarily unavailable to provide supports due to routine and non-routine circumstances. This service provides a person with personal assistance in daily living activities (e.g., grooming, eating, bathing, dressing and personal hygiene) and functional living tasks. The service includes assistance with:

  • planning and preparing meals;
  • transportation or assistance in securing transportation;
  • assistance with medications and the performance of tasks delegated by a registered nurse in accordance with state law; and
  • supervision of the person’s safety and security.

Respite also includes habilitation activities:

  • use of natural supports and typical community services available to all people;
  • social interaction and participation in leisure activities; and
  • assistance in developing socially valued behaviors and daily living and functional living skills.

Residential Services – Twenty-four hour services provided to a person who does not live independently or with his or her natural family. These services are provided by employees or contractors of the LIDDA who regularly stay overnight in the person’s home.

Screening – Gathering information to determine a need for services. This service is performed face-to-face or by telephone contact with persons. Screening includes the process of documenting a person’s initial and updated preferences for services and the LIDDA’s biennial contact of persons on the Home and Community-based Services (HCS) Interest List and the Texas Home Living (TxHmL) Interest List.

Service Coordination – Assistance in accessing medical, social, educational, and other appropriate services and supports that will help a person achieve a quality of life and community participation acceptable to the person as described in the Plan of Services and Supports. Service coordination is provided by a LIDDA staff person who is referred to as a service coordinator. Service coordination functions are:

  • Assessment – Identifying the person’s needs and the services and supports that address those needs as they relate to the nature of the person’s presenting problem and disability;
  • Service Planning and Coordination – Identifying, arranging, advocating, collaborating with other agencies and linking for the delivery of outcome-focused services and supports that address the person’s needs and desires;
  • Monitoring – Ensuring that the person receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual’s needs and desires; and
  • Crisis Prevention and Management – Linking and assisting the person to secure services and supports that will prevent or manage a crisis.

Note: If the person has the appropriate type of Medicaid, this service should be billed as targeted case management.

Specialized Therapies – Training and consulting with family members or other providers and assessment and treatment by licensed or certified professionals for:

  • social work services;
  • counseling services;
  • occupational therapy;
  • physical therapy;
  • speech and language therapy;
  • audiology services;
  • dietary services; and
  • behavioral health services, other than those provided by a local mental health authority (LMHA) pursuant to its contract with the Department of State Health Services (DSHS).

Supported Employment – Provided to a person who has paid, individualized competitive employment in the community (i.e., a setting that includes non-disabled workers) to help the person sustain that employment. It includes individualized support services consistent with the person-directed plan as well as supervision and training.

Vocational Training – Day training services provided to a person in an industrial enclave, a work crew, a sheltered workshop or an affirmative industry to enable the person to obtain employment. Contract funds are not used for the cost of production.

20200 GR Services

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) determines which General Revenue (GR) optional services they will make available for GR eligible persons based on their local planning activities described in the LIDDA Performance Contract.

LIDDAs are not required by contract to provide any of the services listed below, except for screening, eligibility determination, respite and service coordination.

Services include:

  • screening;
  • eligibility determination;
  • service coordination;
  • community support;
  • respite;
  • employment assistance;
  • supported employment;
  • day habilitation;
  • nursing;
  • behavioral supports;
  • specialized therapies;
  • vocational training; and
  • residential services.

Note: All GR funded services should be delivered in accordance with the Service Definition Manual.

20300 Eligibility

Revision 20-4; Effective October 15, 2020

To be eligible for General Revenue (GR) services, a person must have one of the following:

  • A diagnosis of an intellectual disability, which is based on:
    • a measure of the person’s intelligence quotient (IQ);
    • a determination of the person’s adaptive behavior level (ABL); and
    • evidence of the disability that originated before the person’s 18th birthday.
  • A diagnosis of autism spectrum disorder.
  • Eligibility for early childhood intervention (ECI) services.

20400 LIDDA Responsibilities

Revision 20-4; Effective October 15, 2020

Each local intellectual and developmental disability authority (LIDDA) is responsible for ensuring the provision of, and oversight of, General Revenue (GR) services described above that is responsive to the needs of its local service area.

Each LIDDA must have policies and procedures that ensure ongoing assessments are conducted for a person, and the general revenue services in the person’s plan of services and supports are coordinated and monitored in accordance with 40 Texas Administrative Code (TAC) §2.556 and §2.561. There are no required Health and Human Services Commission (HHSC) forms to be used by the LIDDA at this time. Each LIDDA has the authority to create and use their own forms, if they encompass the requirements listed here.  

Each LIDDA must have policies and procedures related to respite (in-home, facility based, or both) funded by GR that:

  • encourages the use of existing local providers of respite;
  • encourages participation by the person and LAR or actively involved person in the choice of a qualified provider of in-home respite;
  • describes how in-home respite providers are selected and trained;
  • describes how emergency backup for in-home respite providers is provided;
  • addresses admission procedures; and
  • requires development of a respite plan prior to the delivery of respite except in an emergency.

In accordance with 40 TAC §2.556, the LIDDA must conduct an annual review of the person’s plan, which includes the services being provided and outcomes to be achieved.

20410 Termination of GR Services

Revision 20-4; Effective October 15, 2020

General Revenue (GR) services can be terminated if the person moves out of the local service area, the person no longer meets eligibility criteria or if the person chooses not to receive any GR services.

For people moving out of the local service area, once notified, the local intellectual and developmental disability authority (LIDDA) will assist the person or their legally authorized representative (LAR) with setting up an intake at the receiving LIDDA and transferring records, including changing the county of residence in the Client Assignment and Registration (CARE) System and transferring Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Interest List (IL) status. 

20420 GR Interest List

Revision 20-4; Effective October 15, 2020

Every local intellectual and developmental disability authority (LIDDA) must maintain a General Revenue (GR) Interest List (IL) for its local service area. The GR IL consists of persons who have completed eligibility determination with the LIDDA and requested GR funded services which were not available at the time of request. Persons are placed on the IL on a first-come, first-served basis.

In accordance with the LIDDA Performance Contract, since resources are insufficient to meet the service needs of every person in the priority population, services should be provided to meet the most intense needs first. Intense needs are determined as follows:

  • a person is in danger or at risk of losing his or her support system, especially the living arrangement or support needed to maintain self;
  • a person is at risk for abuse or neglect;
  • a person’s basic health and safety needs are not being met through current supports;
  • a person is a risk for functional loss without intervention or preventive or maintenance services; or
  • a person demonstrates repeated criminal behavior.

Note: See the LIDDA Performance Contract for a description of the LIDDA priority population.

20421 GR Interest List Reporting Requirements

Revision 20-4; Effective October 15, 2020

The local intellectual and developmental disability authority (LIDDA) must submit their local General Revenue Interest List in a format approved by HHSC on a quarterly basis as indicated in the IDD Submission Calendar in the LIDDA Performance Contract.