Documents
Instructions
Updated: 10/2024
Note: A person in this form refers to an individual as defined in 26 Texas Administrative Code (TAC) Sections 262.3.
Purpose
Texas Health and Human Services Commission (HHSC), TxHmL waiver program providers and Local Intellectual and Developmental Disability Authorities (LIDDAs) use Form 8582, Texas Home Living program (TxHmL)/Community First Choice (CFC) Individual Plan of Care (IPC), to document a person’s TxHmL, CFC and non-TxHmL or CFC services.
IPC – Individual plan of care. A written plan that states:
- the type and amount of each TxHmL program service and each CFC service, except for CFC support management, to be provided to a person during an IPC year.
- the services and supports to be provided to the person through resources other than TxHmL program services or CFC services, including natural supports, medical services and educational services.
- if a person will receive CFC support management.
- it is authorized by HHSC.
Form 8582, The Individual Plan of Care must be completed per Texas Administrative Code, Title 26, Part 1, Chapter 262, Texas Home Living Program and Community First Choice, Section 262.301 IPC Requirements and Section 262.302 Renewals and Revision of an Individual’s IPC.
Procedure
When to Prepare
The IPC is developed in the following events:
- Enrollment – After members of the service planning team (SPT) develop a person-directed plan (PDP) for an applicant, the service coordinator (SC) and the applicant or LAR develop the proposed enrollment IPC based on the PDP. When the person has chosen a program provider, the SC must review the proposed enrollment IPC with the selected program provider to negotiate and finalize the proposed enrollment IPC. Before the applicant's service begin date, the LIDDA must provide a copy of the enrollment IPC approved by HHSC to the selected program provider and FMSA, if applicable.
- Renewal – Annually, and before the expiration of an IPC, the SPT review and revise the PDP and IPC to determine if individual outcomes and services previously identified remain relevant. The SC works with the SPT to revise the PDP and IPC in response to changes in the person’s needs and identified outcomes.
- Transfer – The SPT develops a transfer IPC when a person transfers to another TxHmL program provider or is choosing a different service delivery option, either to change from receiving services from the agency option to CDS option or from CDS option to the agency option.
- Revision – The two types of IPC revisions are to:
- change the amount or type of TxHmL or CFC services, including an IPC revision to only add or change a requisition fee.
- add or change CFC Support Management Only. This type of IPC revision is used to add or change CFC Support Management if requested. A person must be receiving CFC services to receive CFC Support Management.
Submission
The LIDDA SC submits the proposed enrollment IPC, annual IPC renewals, transfer IPCs and necessary IPC revisions to HHSC.
Form
The program provider or CDS employer and the SC must maintain a copy of the completed Form 8582 in the person’s record.
Questions
To learn about IPC enrollment or transfers related to Form 8582 or instructions, call the HHSC Intellectual and Developmental Disability (IDD) Program Eligibility and Support message line at 512-438-2484.
To learn about IPC revisions or renewals related to Form 8582 or instructions, call the HHSC Intellectual and Developmental Disability (IDD) Waivers Utilization and Review message line at 512-438-5055.
Detailed Instructions
Before entering an IPC in the HHSC data system, Form 8582 must be completed and signed by the required SPT members. The hard copy of the IPC in the person’s record on file with the TxHmL provider or the CDS employer and LIDDA must match the IPC data entered in the HHSC data system.
Page 1
Name of Person — Enter the person’s last name, first name and middle initial.
Address — Enter the person’s current physical address.
Date of Birth — Enter the person’s date of birth.
Age — Enter the person age.
Level of Need — Enter the person’s currently authorized level of need.
Medicaid No. — Enter the person’s Medicaid number.
IPC Begin Date — Enter the begin date of the IPC. This is the 12-month period that starts on the date an initial or renewal IPC begins. A revised or transfer IPC does not change the begin or end date of an IPC year.
IPC End Date — Enter the date the IPC year ends. An IPC end date is 365 days after the IPC begin date or 366 days during a leap year. The current begin and end date of an IPC can be obtained from the HHSC data system.
IPC Type — Select the IPC type that describes the reason for completing the IPC. Check only one:
- Enrollment (Initial)
- Revision
- Annual Renewal
- Transfer: Contract or Service Delivery Option
- Revision for CFC Support Management Change Only
Effective Date — Enter the IPC effective date as described below.
- Enrollment (Initial) – The IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date.
- Revision – The IPC effective date must be on or after the IPC meeting date.
- Annual Renewal – The IPC effective date is the same as the IPC begin date. The IPC meeting must be held on or before the IPC effective date.
- Transfer: Contract or Service Delivery Option – The IPC effective date is when the person will begin to receive services from the receiving program provider. The IPC meeting must be held on or before the IPC effective date.
- Revision for CFC Support Management Change Only – The IPC effective date must be the date when CFC support management was changed or added.
Program Provider Information
If the person is self-directing all TxHmL service through the CDS option, skip to the FMSA Information section of these instructions.
If the person is receiving any TxHmL or CFC services from a program provider, enter the following information:
- Program Provider — Enter the legal name of the program provider. Do not enter the doing-business-as (DBA) name.
- Vendor No. — Enter the program provider's vendor number.
- Location Code — Enter OHFH (own home family home).
- Contract No. — Enter the program provider’s contract number.
- County of Service — Enter the name of the county in which the person resides.
I or D — For an existing TxHmL service, indicate the need to increase or decrease the service with an I for increase or D for decrease in the column next to the service.
Authorized Units —Enter the requested amount of each TxHmL service to be provided by a program provider for the IPC year. For an IPC revision or for a transfer IPC, enter the total amounts already provided from the IPC begin date through the revision or transfer effective date and amounts to be provided from the revision or transfer effective date through the end date of the IPC.
FMSA Information
If the person is not using the CDS option, skip to Page 2.
If the person is self-directing any TxHmL or CFC services through the CDS option, enter the following information:
- Financial Management Services Agency (FMSA) — Enter the name of the FMSA.
- FMSA Contract No. — Enter the contract number for the FMSA connected to the person.
- FMSA Vendor No. — Enter the FMSA's vendor number.
I or D — For an existing TxHmL service to be provided through the CDS option, indicate the need to increase or decrease the service with an I for increase or D for decrease in the column next to the service.
Authorized Units — Enter the requested amount of each TxHmL service to be provided through the CDS option for the IPC year. For an IPC revision or for a transfer IPC, enter the total number amount already provided from the IPC begin date through the revision or transfer effective date as well as the amounts to be provided from the revision or transfer effective date through the end of the IPC.
Authorized Dollars — Enter the requested dollar amount of each service provided through the CDS option for the IPC year. Multiply the authorized units by the rate of service for the dollar amount. For an IPC revision or transfer IPC, enter the sum of dollar amounts already provided from the IPC begin date through the revision or transfer effective date and dollar amounts to be provided from the revision or transfer effective date through the end of the IPC.
Page 2
Are any Services determined critical and require a service back-up plan? — Select Yes or No.
Are any services included on this IPC staffed by a relative or guardian? — Select Yes or No.
Summary Totals for TxHmL Services — To make sure accurate calculations are captured on the hard copy of the IPC, enter the IPC into the HHSC data system and fill in the following fields. The HHSC data system auto-calculates these fields based on units/dollars for services entered.
- Estimated TxHmL Program Provider Annual Total
- Estimated FMSA Annual Total
- Estimated IPC Total
CFC Services
Will the person receive CFC Support Management? — Select Yes if the person’s PDP indicates CFC support management or No if the person’s PDP does not indicate CFC support management.
If revision or change to add CFC Support Management, enter date — Enter the date when CFC support management was changed or added. An IPC revision to add CFC support management would not be electronically transmitted to HHSC for authorization. The addition of CFC support management would only be reflected on the hard copy of Form 8582. The required SPT members must sign and date the IPC.
I or D —Indicate the need to increase or decrease an existing CFC service. Enter I for increase or D for decrease in the column next to the service.
Authorized Units — Enter the requested amount of each CFC service to be provided by the TxHmL program provider or CFC service provided under the CDS option for the IPC year. For an IPC revision or a transfer IPC, enter the total amount provided from the IPC begin date through the IPC effective date. Also enter the total amount to be provided from the IPC effective date through the end date of the IPC.
Authorized Dollars — Enter the requested dollar amount of each CFC service provided under the CDS option for the IPC year. Multiply the authorized units by the rate of the service for the dollar amount. For an IPC revision or transfer IPC, enter the sum of dollar amounts already provided and dollar amounts to be provided in the future.
To make sure accurate calculations are captured on the hard copy of the IPC, enter the IPC into the HHSC data system and complete the following fields. The HHSC data system auto-calculates these fields based on units/dollars entered.
- CFC Annual Total
- TxHmL and CFC Annual Combined Total
Non-Waiver Funded Day Activity – If the person participates in day activities not funded by the TxHmL program, complete this section for each non-waiver funded day activity the person attends.
- Name of Day Activity – Enter the name of the non-waiver day activity the person attends.
- Address – Enter the address of the non-waiver day activity the person attends.
- No. of Hours Per Day – Enter the average number of hours a day the person attends a non-waiver day activity.
- No. of Days Per Week – Enter the average number of days per week the person attends the non-waiver day activity.
- Type of Services Provided – Describe types of services provided or what the person does at the non-waiver funded day activity.
Educational Services – Complete this section if the person receives educational services.
- Name of School – Enter the name of the school the person attends.
- Address – Enter the address of the school the person attends.
- No. of Hours Per Day – Enter the number of hours per day the person attends school.
- No. of Days Per Week – Enter the average number of days per week the person attends school.
- Type of Services Provided – Enter services provided in addition to educational services, such as physical therapy, occupational therapy.
Non-Waiver Services Provided by Family – Complete this section if family provides non-waiver funded services.
- Type of Service – Enter the type of non-waiver services the person receives or will receive from a family member.
- Service Description – Enter a brief description of the non-waiver service the person receives from a family member.
- No. of Hours Per Day – Enter the average number of hours per day the person receives a non-waiver service from a family member.
- No. of Days Per Week – Enter the average number of days per week the person receives a non-waiver service from a family member.
- Name of Provider – Enter the name of the family member who provides the service.
- Relationship to the Person – Enter the non-waiver service provider’s relationship the person.
Services Provided by Other Funding Sources
- Type of Service — Enter a brief description of the type of service the person receives or will receive. This includes any non-TxHmL waiver or CFC services provided to the person.
- Name of Provider — Enter the name of the family member or agency providing the service.
- Funding Source — Enter the name of the funding source for the service.
Page 3
Service Coordinator Response — For certifications completed during enrollment or renewals
- Person or LAR was informed upon enrollment of the person’s rights and responsibilities. — The SC checks this box only during an enrollment if the person or LAR was informed of the person’s rights and responsibilities.
- Person or LAR was informed upon enrollment of the process for filing a complaint and reporting allegation of abuse, neglect or exploitation. — The SC checks this box only during an enrollment if the person or LAR was informed of the process for filing a complaint and reporting allegation of abuse, neglect or exploitation.
- Person or LAR has been informed upon enrollment and annually of the person’s option to transfer to other program providers as chosen by the person as often as desired. — The SC checks this box during enrollment and renewals if the person or LAR was informed of the person’s option to transfer to other program providers as chosen by the person as often as desired.
Service Planning Team Signatures
Signature – Before electronic transmission to HHSC, the required SPT members must sign and date a person’s IPC indicating agreement that TxHmL and CFC services for the person are not available through other resources, are necessary to prevent institutionalization, assure health and safety, and are based on outcomes on the person-directed plan.
- LIDDA Service Coordinator — Signature of the SC who coordinated the development of the IPC.
- Printed Name — Enter the printed name of the SC who signed the IPC.
- Date — Enter the date the SC signed the IPC.
- Signature – Person or LAR — The person must sign unless there is an LAR, in which case the LAR's signature is required.
- Date — Enter the date the person or LAR signed the IPC.
- Signature-FMSA – Signature of the FMSA representative if a person chooses the CDS option for any services. The signature of the FMSA is not required.
- Date – Enter the date the FMSA representative signed the IPC
TxHmL Program Provider Agency Name – Enter the legal name of the program provider if the person chooses the agency option for any services. Do not enter the doing business as (DBA) name.
- Signature — Program Provider Representative — Signature of the program provider representative if the person chooses the agency option for any services.
- Printed Name — Enter the printed name of the program provider representative who signed the IPC.
- Date — Enter the date the program provider representative signed the IPC.
HHSC Review and Authorization if required
- Signature – HHSC Authorized Representative — The HHSC authorized representative signs the form should a utilization review be conducted.
- Date — The HHSC authorized representative enters the date they completed the IPC utilization review.