Revision 21-2; Effective June 1, 2021

 

Workflow and Time Frames for Expediate and Immediate

Time Frames Action
Intake received and determined to be expedited or immediate Schedule the visit and assess the applicant within the appropriate time frame for an immediate referral (24 hours) or an expedited referral (five calendar days).
By the next business day from the home visit date Make an oral request to the provider to begin pre-initiation activities and negotiate a date for the completion of pre-initiation activities (which is less than 14 days). CCSE staff then send the referral packet, including Form 2101, with the negotiation information in the comments.
By the negotiated date The provider calls CCSE staff and provides the information from the completed Form 3052. CCSE staff and the provider negotiate a start date.
Within five business days after the negotiation contact from the provider Send Form 2101, Authorization for Community Care Services to the provider, entering the negotiated start date in Item 4.
Within two business days from the negotiated start date. Complete and send Form 2065-A, Notification of Community Care Services, to the applicant.
Within seven business days from the negotiation contact The provider sends CCSE staff Form 3052.

 

Workflow and Time Frames for a Routine Primary Home Care (PHC) Referral

Time Frames Action
Within 14 calendar days after receipt of intake Schedule a visit and complete an assessment. The application must be completed within 30 calendar days from the assessment date.
Within five business days after the home visit (The date of the home visit is day "0.") Enter the assessment information in the Service Authorization System Online Wizard (SASOW) and send the provider a referral packet.

This begins the pre-initiation activities.
Within 14 calendar days after receipt of referral packet The provider completes the pre-initiation activities, obtains Form 3052, Practitioner's Statement of Medical Need, and sends the form to HHSC.
Within five business days after receipt of Form 3052 (The date of receipt of Form 3052 is day "0.") Review Form 3052. If complete, send Authorization Form 2101 to the provider. The "Mail Date" (Item 1) and the "Begin Date" (Item 4) are the same date.
Within two business days of the Begin Date on Form 2101 Complete and send Form 2065-A, Notification of Community Care Services, to the applicant.
Within 30 calendar days of assessment or face to face contact Send the Authorization Form 2101 to the provider to complete the application.
Within seven calendar days after Receipt of Form 2101 The provider initiates services.

 

Workflow and Time Frames for an Initial Referral for Community Attendant Services (CAS)

Time Frames Action
Within 14 calendar days after receipt of intake Schedule a visit and assess the applicant for services. Note: If the intake is immediate or expedited, schedule according to the appropriate time frame. Unless new intakes are being placed on the interest list by the region, a referral to Family Care is mandatory for immediate or expedited intakes.
Within two business days after receipt of the application form (Date of receipt is day "0.") Fax Form H1746-A, MEPD Referral Cover Sheet and Form H1200, Application for Assistance – Your Texas Benefits, to the Medicaid for the Elderly and People with Disabilities (MEPD) staff.
Within seven business days after receipt of the eligibility notification from MEPD Enter the assessment information in the SASOW and send the provider a referral packet.

This begins the pre-initiation activities.
Within 14 calendar days after receipt of the referral packet The provider sends Form 3052 to the HHSC nurse. The provider may send a courtesy copy of Form 2101.
Within five business days after receipt of completed Form 3052 (The date of receipt of Form 3052 is day "0.") The HHSC nurse enters the information in SAS and sends the provider Form 2101 with a copy to CCSE staff.
Within two business days after receipt of Form 2101 from the HHSC nurse (The date of receipt is day "0.") Send the applicant Form 2065-A.
Within seven calendar days after receipt of authorization on Form 2101 The provider initiates services.

 

Workflow and Time Frames for a CAS Reassessment

Time Frames Action
Within 12 months after the previous assessment Conduct a home visit for the annual reassessment.
Within five business days after the home visit Send referral Form 2101, as a referral, to the provider. If there are no changes in the service plan, leave the "Begin Date" blank. If there are changes in the service plan, enter the "Begin Date" according to the action:
  • The effective date for an increase is seven calendar days from the Item 1 (Mail Date) on Form 2101.
  • The effective date for a decrease is 12 days from the Item 1 (Mail Date) on Form 2101. This date must match the date on Form 2065-A.

Send Form 2065-A to the person to notify them of the change in the service plan. A person is entitled to be notified 10 days before any reduction or termination of their services, or to have the notification mailed 12 days before the date of reduction or termination.
Within 14 calendar days after receipt of Form 2101 from the case worker The provider sends Form 2101 and signed statement of the agreement or disagreement* with the plan to the HHSC regional nurse.
Within five business days after receipt of Form 2101 from the provider The HHSC nurse reviews the service plan and completes the authorization in the Authorization Wizard. The nurse sends Authorization Form 2101 to the provider and CCSE staff.

* If the provider disagrees with the service plan, within five business days the HHSC nurse negotiates with the provider and CCSE staff to arrive at an agreement.

If Form 2101 is not received from the provider within 21 calendar days, the HHSC nurse contacts the provider to request the form.

 

Workflow and Time Frames for a Day Activity and Health Services (DAHS) Referral

Time Frames Action
Within 14 calendar days after receipt of intake Schedule a visit or contact the applicant by phone and assess the applicant for services.
Within five business days after the assessment Enter the assessment information in SASOW and send the provider a referral packet.
This begins the Pre-Initiation Activities.
Within 14 calendar days after receipt of the referral packet The provider sends the prior approval request packet to the HHSC regional nurse, which includes:
  • Form 2101;
  • Form 3050, Day Activity and Health Services (DAHS) Health Assessment/Individual Service Plan; and
  • Form 3055, Physician's Orders (DAHS).
Within five business days after receipt of the packet (The date of receipt of the packet is day "0.") The HHSC regional nurse determines if the applicant meets the medical criteria for DAHS and if so, enters the information in SAS. The nurse sends approval or denial to the provider on authorization Form 2101 with a copy to CCSE staff.
Within two business days after receipt of Form 2101 from the HHSC Regional Nurse (The date of receipt is day "0.") Send the applicant Form 2065-A to notify them of the eligibility determination.
Within seven calendar days after the Begin Date on Form 2101 The provider initiates services, unless the applicant has been attending the facility under a facility-initiated referral.