Revision 19-1; Effective September 19, 2019

 

In order to provide and bill for habilitation coordination, a habilitation coordinator must be a LIDDA employee who meets the qualification requirement described in 26 TAC §303.501.

 

4100 Habilitation Coordination Service Authorization Revision

19-0; Effective July 7, 2019

 

The habilitation coordinator must send a request for habilitation coordination service units from HHSC. To be paid for participating in the initial IDT meeting, a request must be sent using designated Form 2358, Habilitation Coordination Authorization Request, and faxed to the HHSC Provider Claims section at 512-438-2301 within three business days of the initial IDT for processing. If the IDT agrees to the provision of habilitation coordination for the individual, the LIDDA requests habilitation coordination for 12 months effective the date of the IDT meeting.

Service authorizations may take five to seven business days to appear on Medicaid Eligibility and Service Authorization Verification (MESAV).

 

4110 Habilitation Coordination Service Authorization Requests

Revision 19-0; Effective July 7, 2019

 

There are six habilitation coordination authorization requests that the habilitation coordinator will identify on Form 2358, Habilitation Coordination Authorization Request, that will be processed by HHSC staff:

  • Initial — LIDDA requests initial authorization for habilitation coordination for 12 units for one year if the individual accepts a recommendation for habilitation coordination.
  • Refusal — LIDDA requests one unit to cover the initial IDT if the individual refuses habilitation coordination.
  • Renewal — LIDDA requests renewal of authorization for habilitation coordination (12 service units) for the next year.
  • CLO — LIDDA requests one additional unit of habilitation coordination to provide CLO in accordance Section 5810.1 of the IDD PASRR Handbook for an individual who has refused habilitation coordination.
  • Revision — LIDDA requests additional units of habilitation coordination. This usually occurs when an individual requests habilitation coordination after an initial refusal.
  • Termination —There are two types of termination:
    • Voluntary: When an individual, or LAR on his or her behalf, requests an end to habilitation coordination.
    • Involuntary: The second type is to request an end to an authorization for habilitation coordination for an individual who has transferred to an NF in the service area of another LIDDA.

 

4120 Termination Codes

Revision 19-0; Effective July 7, 2019

 

For all terminations submitted by the habilitation coordinator, an accompanying code will need to be used to reflect what type of termination is being submitted. Below are the codes:

Code Description
1 Client Leaves the LIDDA’s catchment area
2 Death of Client
5 Client Requests Service Termination
23 Transferred to Another Service
29 Discharged from Facility (Assumed to Home)
32 Hospitalized over 30 days
39 Other

 

4200 Units of Service

Revision 19-1; Effective September 19, 2019

 

A billable unit of service is the method for calculating the amount the habilitation coordinator may bill HHSC. HHSC established the habilitation coordination rate based on an assumption of a caseload of 26 individuals served within any given calendar month. For the first year of implementation, HHSC will not be imposing a contractual requirement that LIDDAs maintain a caseload of 26 individuals. HHSC encourages and expects that LIDDAs will maintain manageable caseloads that continue to support the integrity and quality of habilitation coordination that PASRR residents receive. Rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid website (see Fee Schedules).

Service Procedure Code Modifier Rate Unit Effective
Habilitation Coordination S0311 96 $208.23 Monthly 7/7/2019

 

The number of habilitation coordination units needed by the individual are determined by the IT or SPT and documented on the HSP. The monthly habilitation coordination fee may only be billed during a month when a billable activity has occurred. Habilitation coordination progress notes must include the following elements:

  • the date of habilitation coordination encounter;
  • description of the service provided (e.g., assessment, service planning and coordination, monitoring, or crisis prevention and management);
  • place of encounter;
  • actual begin time and duration of encounter;
  • detailed description of the encounter;
  • the person with whom the contact occurred; and
  • the habilitation coordinator who provided the contact including name and title.

Elements noted above do not necessarily have to be contained within the narrative describing the encounter as long as they are contained within the progress note that also contains the narrative (e.g., billing strip).

 

4210 SASO Codes

Revision 19-0; Effective July 7, 2019

 

A service authorization for habilitation coordination is created in the Service Authorization System Online (SASO) by designated HHSC staff for one unit per month requested, for up to 12 months, with effective the date of the IDT or the date that the habilitation coordinator meets with the individual. The service authorization is identified as a Service Group (SG) 14 or “SG 14,” which means the LIDDA is the provider. The service code for which is associated with “habilitation coordination” is 10H provided by a LIDDA.

 

4300 Service Claim Requirements

Revision 19-0; Effective July 7, 2019

 

For habilitation coordination services to be reimbursed, there must be at least one face-to-face meeting with an individual delivered by a qualified provider employed by the LIDDA. A LIDDA must submit an electronic service claim for habilitation coordination that meets the requirements specified by Texas Medicaid & Healthcare Partnership (TMHP).