Form 8591, Community Services Interest List (CSIL) Data Entry

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Documents

Effective Date: 4/2022

Instructions

04/2022

Purpose

Form 8591 is used by the local intellectual and developmental disability authority (LIDDA) to collect information for data entry into the Texas Health and Human Services Commission (HHSC) Community Services Interest List (CSIL) application.
The LIDDA representative documents the information on the form for the LIDDA data entry staff to enter in the CSIL application.

When to Prepare 

Initially, the LIDDA completes the form during the interview process to add the person to the Home and Community-based Services (HCS) and/or Texas Home Living (TxHmL) interest list. Subsequently, the LIDDA completes the form when correcting or updating the person’s interest list.

Submittal 

The LIDDA maintains a copy of the form in the person’s record at the LIDDA site. The LIDDA submits a copy of the form to HHSC only upon request.

Detailed Instructions

Section 1, LIDDA Information

Date – Enter the date the form was completed.

LIDDA Component Code — Enter the component code of the LIDDA.

LIDDA Name — Enter the name of the LIDDA.

LIDDA Contact Person — Enter the name of the person from the LIDDA completing the form.

Area Code and Phone No. — Enter the area code and phone number for the person completing the form.

Email — Enter the email address for the person completing the form.

Section 2, Person’s Information

Client Assignment Registration (CARE) ID — Enter the person’s CARE ID number. Note: A CARE ID is required to add a CSIL record. If the person does not have a CARE ID, before adding a CSIL record, the LIDDA must register the person in CARE and receive a system-generated CARE ID.

Local Case No. — Enter the person’s local case number. Note: A local case number is required to add a CSIL record. If the person does not have a local case number, before adding a CSIL record, the LIDDA must assign a local case number in CARE.

Gender — Select Female, Male or Unknown.

First Name — Enter the person’s first name.

Middle Name — If applicable, enter the person’s middle name.

Last Name — Enter the person’s last name.

Suffix — If applicable, enter the suffix - II, III, IV, Jr. or Sr.

Date of Birth — Enter the person’s date of birth from the birth certificate or a state ID.

Age — Enter the person’s current age.
 
Social Security No. — Enter the number shown on the person’s Social Security card.

Residence County — Enter the county name where the person currently resides.

Address — Enter the street address where the person currently resides.

City — Enter the city.

State — Enter the state.

ZIP Code — Enter the ZIP code.

Ethnicity — Select from the available options.

Section 3, Primary Correspondent’s Information

Primary Correspondent’s Name — Enter the name of the person’s primary correspondent.

Area Code and Phone No. — Enter the area code and phone number for the primary correspondent.

Email — Enter the email address for the primary correspondent.

Address — Enter the street address for the primary correspondent.

City — Enter the city.

State — Enter the state.

ZIP Code — Enter the ZIP code.

Section 4, Reason for the Interview
 
Select from the available options.

  • Adding a record — Select if there is no existing CSIL record for the person.
  • Updating an existing record — Select if updating an existing CSIL record.
  • Transferring an existing record to a different LIDDA — Select if transferring the person’s CSIL record to another LIDDA.
  • Resides in an active military household — Select if the person is currently residing in an active military household.
  • Not interviewed — Select if the person or primary correspondent could not be contacted for an interview. (Skip to Section 6).
  • Intellectual and developmental disability contact declined — Select if the person or primary correspondent has declined future contacts.

Section 5, Interview
 
1.    Is the person receiving Supplemental Security Income (SSI) benefits? — Select from the available options.
 
2.    Is the person receiving Medicaid benefits? — Select from the available options. If Yes is checked, enter the Medicaid number.

3.    What is the person’s current living arrangement? — Select from the available options.

4.    If currently residing at home (i.e., not in any type of facility), what is the age of the main care giver? — Enter the main caregiver’s age.

5.    If currently residing in any type of facility, what is the name of the facility? — Enter the facility name, the facility admission date and, if applicable, the facility discharge date.

6.    Do you think a move will be needed within one year? — Select from the available options.

7.    When does the person want services? — Select from the available options.

8.    What is the person’s preferred HCS living arrangement? — Select from the available options.

9.    Is the person receiving any of the following community services? — Select all that apply from the available options.

  • AFC = Adult Foster Care
  • AL/RC = Assisted Living/Residential Care
  • CMPAS = Consumer Managed Personal Attendant Services
  • DAHS = Day Activity and Health Services
  • ERS = Emergency Response System
  • Meals = Home Delivered Meals
  • PAS (FC/PHC/CAS) = Personal Attendant Services (PAS), Family Care (FC), Primary Health Care (PHC), Community Attendant Services (CAS)
  • SSPD = Special Services to Persons with Disabilities
  • CLASS = Community Living Assistance and Support Services
  • DBMD = Deaf Blind with Multiple Disabilities
  • MDCP = Medically Dependent Children Program – STAR Kids
  • TxHmL = Texas Home Living
  • HCS = Home and Community-based Services
  • STAR+PLUS Waiver = STAR+PLUS Waiver (aka SPW or HCBS)

Section 6, Interviewer’s Comments

Enter the interviewer’s comments regarding the reason for adding or updating the interest list record (required).

CSIL ID — Enter the system generated CSIL ID (created at the time of data entry).

Data Entry Date — Enter the data entry completion date.

Name of Person Completing Data Entry — Enter the name of the person who entered the information in the CSIL application.

Area Code and Phone No. — Enter the area code and phone number for the person who entered the information in the CSIL application.

Email — Enter the email address for the person who entered the information in the CSIL application.