Twogether Updates

Providers Affected By The Floods in Texas Needing Temporary Client Re-Location

Our good friend, Phil Haas from Beautiful Abilities wanted to share this with the providers affected by the flooding in Texas this month.
“Praying everyone ok.  Devastating, so sorry.

Just reaching out to offer temporary re-location and place if needed, we could help. The ranch in Edge ( just off I-45/Hwy 21) has room up to 8 comfortably (few more with cots)  in Texas room, has bathroom ( 2 -3 other baths available on ranch) , Central AC, shower, kitchen, direct TV and single beds. We also have a spare bedroom in home with queen bed. We can accommodate at our day program as well. We can work out staff support if needed.If longer term, got a 3 BR/2BA house in College Station ( SL approved ) available as soon as October 1 for at least 30-45 days. (it is currently for sale, if someone makes an offer). Has furnishings can get beds set up. Can do temp at ranch until then.

Got lots of friends and big churches who always help, can reach out to them if more needed. I’ll do what I can, just let me know. God bless.”

Contact Phil Haas at 979/571-4900

ICF/IID Updates

Provider Joint Training Opportunity for “Scope & Severity” Webinar

Please register below at the following link. (Hurry, Sessions Are Filling Fast!)

There is a session on Oct. 2nd, 2019 that is still open and 2 more have been added (Nov. 6th 10am and at 2pm)

Check out Joint Provider Trainings link from HHSC, for more info:


Survey Process for ICF Has Changed: Please Be Aware

You may check your SOMA (Surveyor’s Operational Manual for ICF in Appendix J) for these changes.

Look for our live training session coming soon on Appendix Q changes!

“Changes to Appendix Q-Immediate Jeopardy for ICF and What That Means For The Provider”

1-day session in Austin end of August 2019

Appendix Q of SOMA (Immediate Jeopardy) Changes

CMS clarifications letter

Online basic training for Core Appendix Q is available on the Integrated Surveyor Training
Website at the following link:
This basic training is intended to provide Regional Office and State Survey Agency surveyors, management staff, and
training coordinators, as well as providers, suppliers, and laboratories, and other stakeholders with
the ability to identify immediate jeopardy
NOTE: This is a required training for RO and SA staff involved in immediate jeopardy
determinations. All RO and SA surveyors, members of management, and training coordinators
are expected to take this training as soon as practicable, but not later than March 22, 2019.
Point of Contact:
For questions related to this information, please add in subject line
“Immediate Jeopardy Inquiry” and send your email to:  
Effective Date:
Immediately-This policy should be communicated to all survey and certification staff, their managers and the State
and Regional Office training coordinators within 30 days of this memorandum.


SOMA appendix Q Section  Immediate Jeopardy


II.  Proposed ICF/IID Rates: Below please find the link to information about the August 2, 2019 HHSC public hearing on the proposed ICF/IID rates.  The hearing will be at 3:00 p.m. and held in the HHSC public hearing room (first floor of HHSC).  Additional information about the hearing (specifically, needed member action) will be forthcoming.
Though the above link provides the proposed rates, below is a chart which reflects both the current and proposed ICF/IID rates.  Note that with the exception of LON 9, all LON categories and facility settings/sizes are proposed to receive an increase.  Also, at this time, the specifics regarding the impact of the increases on the rate categories (residential direct and indirect  & day habilitation direct and indirect) are not yet available.  According to HHSC the ‘specifics’ should be available on or after this Friday (July 19, 2019).

LON & Facility Size

Current Rates

Proposed Rates

























































HCS Provider Applicant Training (PAT) & Testing Status

New HCS/TxHmL Applicant Provider Training/testing session Oct. 8th-10th, 2019.  Testing will be on 3rd day (Oct. 10th)

We believe their may be another PAT session in December 2019, but we don’t have definitive knowledge yet.  We will post a study prep session this coming week of Sept. 23rd. We will have the study prep class the evening of the 1st day of the PAT training on Oct. 8th, 2019 from 6:00pm-9:00pm  As soon as we find out the location, we will post it.  The PAT location has changed, so we would like to find a location closer to the PAT training so that it is convenient for the HCS provider applicants. Thank you all for your patience.

These past 6 months have been very trying for new HCS/TxHmL applicants, as HHSC appears to have gone through some massive changes in processes at enrollment and contracts and in staff. So happy that many of you have received your letters of invite to the PAT and we can now move closer to your goal of becoming an HCS Provider!  Please be sure to study both the HCS TAC and the TxHmL TAC (if you are taking both tests).

For any other applicants, we are assisting currently, please remember to contact us when you received any communications from HHSC!!

Status of ICF/IID Rates!

Approved ICF Rates:  09/12/19

Click on the link below to read HHSC’s notice to ICF/IID providers about the ICF/IID rates.  The notice informs providers that the rates have been approved but at a lower rate than proposed.  The notice further explains that errors in the calculation of the rates resulted in the variance between the rates proposed versus the rates finally approved. 
The rates will be retroactive to September 1, 2019.  Providers will receive a supplemental payment to cover the difference between services already billed/payments already received based on the FY 2019 rates and the newly adopted FY 2020 rates.


Enforcement of ICF/IID Administrative Penalties Begins Sept. 1

HHSC Long-term Care Regulatory has issued Provider Letter 19-20 Enforcement of State Licensure Violations. The provider letter informs ICF/IID license holders that, effective Sept. 1, 2019, HHSC will begin assessing administrative penalties for licensure violations based on the scope and severity of the violation. Read the details here.

 ICF/IID providers, please remember to contact us for assistance with Survey Prep, Plans of Corrections and especially Directive Inservice Trainings, so we can assist in helping providers avoid administrative penalties, whenever possible!

**Note- I have already put in an email asking about other dates for the scope and severity training webinars as the ones on Sept. 5th are full.


Status of HCS Rates as of Sept 13th, 2019:

Sounds like the week of Sept. 16th, HHSC will schedule to meet with the three provider organizations. HHSC will contact these organizations to discuss in greater detail the concerns with the proposed HCS rates?
Notice to HCS Providers
Re: Delay in Adoption of the HCS Rates: Though previously told HHSC would issue a notice informing HCS providers about the delay in approving/finalizing the HCS rates, HHSC has now decided not to post the notice.
Status of  HCS Rates as of August 30th:  HHSC will issue a bulletin informing stakeholders that the HCS rates are under further review and until the review is completed the current rates will remain in effect.   The review (which includes discussions with the three IDD provider organizations) should be completed before the end of September. 
I. Status of HCS Rates: As of July 17th, 2019-Based on the rate packet issued yesterday it appears HHSC did not accept all of the recommendations PPAT, the Texas Council and PACSTX offered during meetings with HHSC on June 10th and June 14.
As recommended to HHSC, there are no reductions to rates HHSC contends are needed to achieve a ‘fully funded’ rate and no increases (to achieve a ‘fully funded’ rate’) to service rates not widely utilized or in which changes to the Billing Guidelines would help cover their costs. Examples of HHSC’s acceptance of the above stakeholder recommendations include the following:
  • No proposed reductions to the Host Home rates.
  • No proposed increases to therapy rates.
  • No proposed reductions to the Residential Service rates for LONs 1, 5 and 8 (service rates, however, it is believed that it should be increased to be consistent with the intent of Rider 44).
  • No proposed reduction to the Day Habilitation LON 9 rate (another service rate that many believe should be increased).
However some of the stakeholder recommendations related to the following service rates were not accepted as hoped, but HHSC proposed the following:
  • Increases to only two of the five Residential (3 and 4 persons homes) LON service rates; i.e., LONs 6 and 9.  [According to HHSC, to achieve a fully funded rate, the current rates for LONs 1, 5 and 8 should be reduced.]  Yikes!
  • Increases to only three of the five Day Habilitation LON service rates; i.e., LONs 1, 5, and 8 [According to HHSC, to achieve a fully funded rate, the current LON 9 rate should be reduced.  Interestingly, however, this same HHSC data indicates the LON 6 DH rate should be increased.]  Strange.

Effective September 1, 2019

PROPOSED RATES:                                                                                                                                                                  HHSC proposes to increase the payment rates for the HCS Supervised Living / Residential Support Services, Day Habilitation, Supported Home Living Transportation, Community First Choice (CFC) Supported Home Living, and CFC Consumer Directed Services Supported Home Living in accordance with the 2020-21 General Appropriations Act, 86th Legislature, Regular Session, 2019 (Article II, HHSC, Rider 44).
The proposed payment rates were calculated in accordance with 1 TAC Section 355.723, which addresses the reimbursement methodology for the HCS program.  See HCS rates packet proposal below for Sept 1st, 2019.  Click on link to HCS rates document. 


Please contact the Rate Analysis Department’s Customer Information Center at (512) 424-6637 or by email at should you have any questions regarding the information in this document.

On-Site Trainings Available Upon Request

Live Trainings On-Site (Please contact us if you want us to provide these trainings on-site for your program):

Care Coordination in the HCS Program, Using Person-Centered Thinking To Develop The IP (Implementation Plan), Changes in the HCS Progam, Quality Assurance, Changes in The Survey Process In HCS (we are adding one for ICF), Changes in The Billing Audit Process in HCS and TxHmL, Nursing in HCS/TxHmL Programs, Common Nursing Errors In The HCS/TxHmL Programs & Corrective Action Planning, ICAP/IDRC/ and LON Increase Packet Training.

ICF: The Role & Responsibilities of the QIDP, DIT on Active Treatment, Changes To the ICF Surveyor’s Guide-Appendix J- “How It Affects Your Program”, as well as DIT Trainings-A/N/E, Expectations of The Nurse From The Direct Support Staff, “Common Nursing Tags in the ICF Program-How to Prevent & Correct Them“, Nursing In The ICF Program as well as ICAP/IDRC/ and LON Increase Packet Training.

Very Important HHSC Alerts!

Blue Gradient

CMS has Approved HHSC’s Request to Delay the EVV Start Date

HHSC’s request to delay the Jan. 1, 2020 electronic visit verification start date for the programs, services, and service delivery options affected by 21st Century Cures Act is approved.

HHSC already requires EVV for about 90 percent of personal care services. This delay allows more time to address EVV implementation challenges for the remaining personal care programs and services. See the full list of delayed programs, services, and service delivery options in the table below.

Providers currently required to use EVV must continue to use EVV under state law and HHSC policy. See the Programs and Services Currently Required to Use Electronic Visit Verification on page 3.

For the programs approved for the delay:

  • HHSC will provide a new EVV start date and more implementation details
  • Providers for these programs should still prepare and train for EVV

For training resources:

Programs, Services, and Service Delivery Options Affected by Delay

Electronic Visit Verification New and Revised Policies for HHSC and MCO Program Providers Effective Sept. 1, 2019

Effective Sept. 1, program providers will be reviewed on using the EVV system to electronically document authorized service delivery visits.
  • New EVV Usage Policy
    • Program providers will be reviewed for visit transactions manually entered into the EVV system and visit transactions rejected by the EVV Aggregator.
    • EVV usage replaces the current EVV compliance plan score reviews.
    • A program provider’s use of preferred and nonpreferred reason codes will not be used to calculate the usage score for visits with dates of service on and after Sept. 1, 2019.
    • Program providers currently required to use EVV will receive a usage grace period for visits with dates of service between Sept. 1, 2019, through Aug. 31, 2020.
  • Revised Policy for EVV Reason Codes and Required Free Text
    • Program providers will be reviewed for appropriate use of reason codes and entry of required free text.
    • Reason codes are required in the EVV system to clear visit exceptions. However, program providers will not be assessed for misuse of reason codes for visits with dates of service between Sept. 1, 2019, through Aug. 31, 2020.
    • Program providers must document required free text—there is no grace period.
  • Revised Policy for EVV Allowable Phone Identification
    • Program providers will be reviewed for allowable home landline phone types used to clock in and clock out of the EVV system.
    • There is no grace period for allowable phone identification reviews.
New EVV Claims Policies 
  • Billing Policy
    • Requires program providers to follow the billing guidelines of their payer for EVV claims.
  • Claims Matching Policy
    • Requires that any claim for EVV services be matched to an accepted visit transaction in the EVV Aggregator, prior to payment of a claim, to confirm that a service visit occurred.
    • An EVV claim that does not match an accepted visit transaction will be denied by the payer.
    • All EVV payers will implement the new claims matching policy on Sept. 1, 2019.
  • Claims Submission Policy
    • Requires program providers to submit EVV claims to Texas Medicaid & Healthcare Partnership for EVV services.
EVV Training, Vendor Selection, Vendor Transfer and Data Elements Policies 
  • New Training Policy
    • Requires HHSC and MCO program providers to complete all required training prior to using an HHSC-approved EVV system and annually thereafter.
    • Program providers using EVV prior to Sept. 1, 2019, will be required to take the EVV Aggregator, portal and policy training on or before Dec. 31, 2019, and annually thereafter.
  • Revised Vendor Selection Policy
    • Requires program providers to select an HHSC-approved EVV vendor within 30 business days of receiving a contract with HHSC or an MCO.
  • Revised Transfer Policy
    • Requires program providers to request a transfer to another HHSC-approved EVV vendor 120 calendar days prior to the desired transfer date.
  • Revised Data Elements Policy
    • Requires the following visit data categories to be electronically verified by an HHSC-approved EVV system:
      • Program provider
      • Type of service performed
      • Member receiving service
      • Date and time of service
      • Location of service delivery
      • Person providing the service
    • Program providers must ensure data elements in the EVV system are accurate and complete.
    • Missing or incorrect data elements in the EVV system will result in rejected visit transactions, denied or recouped claims, inaccurate standard reports and inaccurate data.
Revised EVV Standard Reports Policy
  • Standard reports located in the EVV portal and vendor system are the official reports HHSC and MCOs use for oversight and data analysis, not limited to:
    • HHSC contract monitoring
    • HHSC EVV compliance oversight reviews
    • Fraud, waste and abuse reviews
  • Only EVV portal standard and vendor standard reports will be used during HHSC or MCO contract monitoring, recoupment projects, or other oversight or review activities.
  • EVV visits with date(s) of service prior to Sept. 1, 2019, will be available in the DataLogic Vesta EVV system.
Contact HHSC EVV Operations with any questions.

EVV Tool Kit – Module Nine: EVV Portal Standard Reports and Search Tools

EVV Tool Kit – Module Nine is now available on the HHSC EVV website. This module provides an overview of the standard reports and search tools that will be available in the EVV Portal beginning Sept. 1, 2019. Module nine also includes tips and FAQs.

Register for the live webinar on May 22 to ask your questions about EVV Claims and the EVV Portal. Email questions ahead of time and include in the subject line “webinar question”. Read the frequently asked questions and answers from the webinars.

Subscribe to GovDelivery to receive email alerts when new EVV Tool Kit resources are available.

EVV (Electronic Visit Verification) system starting soon

Pcs must start Jan. 1, 2020

Clock in clock out method

Used by: Mobile app, Computer- at members home, or Member home phone landline

Tool kit on the HHSC EVV website for:FAQWebinars,Web alerts.Tips

Sign up for June 24- Live Q&A Webinar on the HHSC website

EVV Mobile Application Policy Now Available

HHSC EVV Operations has published the EVV mobile application policy. The EVV mobile application policy establishes clock in and clock out requirements, user requirements, and mobile device specifications.

On April 1, 2019, the EVV mobile application became a standard option for clocking in and clocking out of the EVV vendor systems for service providers and their attendants.

The benefits of using the EVV mobile application include:

• Increased auto-verification of visits.
• Reduction of visit maintenance.
• Fast and easy clock in and clock out by the attendant.
• Limited data entry required by the attendant.
• Can be used in the community and does not require a manual visit entry.
• Only records the location when the attendant clocks in and clocks out and cannot track the attendant before, during, and after the visit.
• Free and quick installation of the mobile application.
• Application requires minimal data usage (estimated at less than two megabytes per month).
• Does not use minutes from the attendant’s mobile phone plan.
• No protected health information is stored on the application.

Please contact DataLogic at to receive training and to begin using the EVV mobile application.

For questions regarding this alert, please contact HHSC EVV Operations.

HHSC Launches IDD Operations Portal for HCS, TxHmL, ICF-IID, CFC Non-Waiver Providers and LIDDAs

The Texas Health and Human Services Commission is pleased to announce implementation of the Intellectual and Developmental Disability Operations Portal. Local Intellectual and Developmental Disability Authorities, Home and Community-based Services, Texas Home Living, Intermediate Care Facility for Individuals with Intellectual Disabilities providers may begin registering to use the IDD Operations Portal starting April 1, 2019.

The IDD Operations Portal is an online system that allows secure submission of electronic documents to and from the IDD Program Eligibility and Support and IDD Utilization Review departments. This portal is not replacing any of the systems you use today, such as TMHP or CARE. It is intended to result in a more timely and efficient submission of documents, and allows providers to check the status of submissions online.

A staggered implementation is happening now. Providers and LIDDAs with DBAs starting with C-G can now register for portal access.

Please see the full implementation schedule detailed in the information letter listed here.


Please go to for more information and registration. 
********We also have pre-recorded webinars you can purchase for use at your facility.  Please contact Meghan Jones at: for more information, registration, and payment.


Thanks for all the wonderful feedback on our Diabetic Assessment & Care Planning Webinar on June 3rd!  We had great attendance and so we are excited to announce that our nurse will continue to provide a series of webinars for Nursing “Best Practices” and “Care Planning” on different diagnoses and issues seen in our IDD population. 

Future sessions will include the following nursing topics: 

G-Tubes-Best Practices and Care Planning In IDD Waiver Programs- Oct. 1st, 2019 

Alzheimer’s & Dementia in Our IDD Population as well as part of  our October -Nov. 2019 Webinar sessions.

We are also thinking about “Assessment & Care Planning For The Medically Fragile in IDD Services” (Especially concerning individuals coming from Skilled Nursing Facilities- Monitoring for and prevention of skin care issues and working with individuals with G/T’s and Trachs and more…  This would be a 2 part general session.) 

Current Scheduled Webinars


“G-Tube Clients- Best Practices And Care Planning in IDD Waiver Programs”  (HCS/TxHmL/ICF)

Date:  October 1st, 2019

Time:  10 AM-12:00 PM

Cost: $65/person

For:  Nursing Staff, Quality Assurance Staff, Program Managers, Administrators

Presenter:  Gina Peterson, RN Consultant


-How do I assess an individual with a G-Tube/Peg Tube?  (What am I looking for?)

– Ideas for G/T Care Planning Outcomes and/or Nursing Goals (includes some samples of different nursing guidelines in these areas)

-Things The Nurse Really Needs To Know:

-What Is The Difference Between The Following: Catheter, Peg Tube, J-Tube, G-Tube, a Mickey Button-with Detachable Feeding and Med Tube only?

-When Is A G/T Needed?

-Pre and Post Op Considerations

-Is The Tube Temporary or Permanent?  Can the Process Be Reversed if No Longer Necessary?

-How Often Should The Tube Be Changed- Monthly, Quarterly, Annually, Only As Needed?

-Who Can Change The Individual’s Tube- Surgeon, Gastroenterologist, PCP, FNPC, Nurse (LVN or RN?)

-Enteral Feedings and Nutritional Supplements


-What Needs To Be On Physician’s Orders in Relation To The Individual’s G/T- Type of Tube, Size of Tube (if Applicable), Frequency of Changing Tube and Who Does it, Specifying Route of Medications, Requesting Liquid Meds. When Available, How often H20 flushes occur, etc….?

Best Practices To Address Common G/T Issues- example: prevention of aspiration during G/T feedings, trouble-shooting device malfunctions, monitoring bowel movements 

G-T Issues Needing Immediate or Emergency Attention


-What resources are available for training the Nurses & The UAP’s (Staff)– Previous Provider and Family, HHSC, PCP, Gastroenterologist, Title IX/DME Provider, MCO RN Case Manager, University Libraries, On-Line Videos/Webinars, etc..?

-What kind of training needs should be addressed with UAP’s, the Individual, and/or Family?

-Ideas for training and training tools for the following: (What to Observe and What to Report to The Nurse (ex:blocked tube excoriation of the stoma area, bowel movements), How To Perform Feedings and Flushes, Options on How To Administer Medications (ex: Liquids vs. Pills), and much more. 

– Nurse & Provider ensuring UAP’s and other people involved in individual’s care, have received special needs training


“Survey Process/Status of Administrative Penalties/Common Survey Citations”

Update-11/2019  (HCS/TxHmL)

Date: November 13th, 2019

Time: 10:00 AM-12:30 PM

Presenter:  Julie Blacklock/IDD Waiver Consultant

For: Administrators, Program Managers, Quality Assurance Staff, Care Coordinators, Nursing Staff

Cost:  $45/person


-New Survey Process:

-May 1st, 2019  ( was the initial transition date )

-Sept. 1st, 2019 ( was the initiation of full change in Survey Process)

— What are the changes to process?

–Serious vs Non-serious and other new terminology

–Has the Entrance and Exit process changed?

–Will we still be able to make corrections during the survey?

— How long will WS&C stay on-site during a survey, has that changed?

–Description of type of survey and frequency of each one.

–IR process changes (Informal Dispute Resolution/Informal Resolution)?

-Administrative Penalties 

 -January 1st, 2020 (Penalties are in effect)

-How will they be assessed?  (Serious vs. Non-Serious)

-Penalty Fees

-Commonly Cited Items at Survey (Including Nursing)


More Sept.-Nov. classes will be posted soon here and on the home page of our website.
Previously Recorded Webinar Sessions Available
The following series of 4 webinars have been designed to assist with training of new HCS Case Managers and or those persons at your HCS program, who are responsible for the “Coordination of HCS Services”.  They are now available as pre-recorded sessions for those of you who would like to purchase these webinar links and handouts from this past July and August.  Please contact my assistant at: or myself at to purchase any or all of these sessions. 

Case Management/Care Coordination Webinar Series for HCS Providers 

LIDDA Vs. HCS Provider: “Roles And Responsibilities-Timelines And Communication”

Webinar via Go To Webinar

Time:  2.5 hrs

Cost:  $50/person

You will receive a link to register for the webinar and the training handouts once we have received payment for the session.

For:  HCS Care Coordinator/Case Manager,  Program Manager, Administrator, Quality Assurance Staff, Nurses and more

Description:  This class is designed for anyone who is first starting out in the HCS Waiver Program as a new provider and for those persons coordinating services (case management) for the individuals in the HCS Waiver Program. This class is also effective for Nursing staff who need to know how the program works overall as they are part of the coordination of services for the individuals in the program.  Lastly, this is also a great session for those providing oversight and quality assurance for the program.

The discussion will include:

-What Does the LIDDA (Local IDD Authority) do?

-Who is the SC (Service Coordinator) at the LIDDA and what is their role and responsibilities?

-What are the HCS Provider’s role and responsibilities?

-When does the provider have to communicate with the SC?

-What are the timelines for certain responsibilities and expected communications on both sides?

-Who does “what” during enrollments, transfers, temporary suspensions, and permanent discharges?

-And much more


“Developing The IP (Implementation Plan) with Person-Centered Thinking in The HCS Program”


Time:  2.5 hrs

QA Session from 12:30 pm – 12:45 pm 

Cost: $50 per person

For:  Program Administrators, Program Directors, Care Coordinators, LIDDA Representatives- Service Coordinators, etc..

The webinar will be via “Go To ”Webinar

Instructions for the webinar and training handouts will be sent to your email after payment is made online or check is received.


A review of basic components of a PDP (Person Directed Plan) completed by the LIDDA service coordinator and how this fits in with the IP (Implementation Plan) completed by the HCS provider.

Review of IP components and how to use the PDP to develop the complete IP. Review of some sample IP’S for various services on the IPC ( Individual Plan of Care).

Defining the terms: Action Plan, Desired Outcome, Objective, strategies, justifications.



LON/ICAP/IDRC Training for HCS, TxHmL, and ICF/IID Programs



Time:  2.5 hrs

QA Session from 12:30 pm – 12:45 pm 

Cost: $50 per person

For:  Program Administrators, Program Managers, Care Coordinators/Case Managers, Service Coordinators, Nurses etc..

The webinar will be via “Go To ”Webinar

Instructions for the webinar and training handouts will be sent to your email after payment is made online or check is received.


-A review of the definition of LON (Level of Need) in the HCS, TxHmL, and ICF/IID programs

-What is the ICAP (Inventory for Client & Agency Planning) and how is it utilized?

-When does the provider complete an ICAP and Why Do They Need To?

-What is the IDRC (Intellectual Disability/Related Condition) form

-When is the IDRC filled out and by who?

-What does LON mean (Level of Need)?  (assistance needed, dollars required for that assistance level, etc…)

-How do I get a Level of Need increase?  Who applies for the Level of Need increase?  

-Utilization Review Department- what is their role?  (Monitoring units in CARE and Utilization of services, Approving Levels of Needs, etc…)



“Billable Services In The HCS Program-2019″

You will receive a link to register for the webinar and handouts after we receive payment.


Time:2.5 hrs

Cost:  $65 per person

Presenter:  Julie Blacklock/IDD Waiver Consultant

For: Administrators, Program Managers, Quality Assurance Staff, Care Coordinators, Nurses, Billing/Data Entry Staff


-Definition of all Billable Services on the IPC (Individual Plan of Care)

Hourly and Daily Unit services such as RSS/SL, HH/CC, CFC (PAS-HAB), DH, REH, PT, OT, SP, DI, BES, CRT, AU, SW, CDS, etc…

-Other Services (Units in dollars only):  Adaptive Aids, Minor Home Modifications, Dental, Pre-Minor Home Mod and OT Assessment, TAS

– Recent and some Upcoming Changes in the HCS Billing Guidelines

-How does this affect the Provider?

-How can I use this change to improve services

-How do I document to capture the most billing?-How to prevent billing for non-billable services?


Free Webinar Series

I have decided to start providing some short helpful webinars for free.  After the initial webinar date, the recordings will still be available.  Most will be about 30 mins to 1hr long. I will be posting them on the website as well:

Some of the topics I would like to include are: How to download and open those annoying pdf forms from the HHSC website and actually be able to read them.  (This is just based on the fact that people complain about this almost weekly to me and I am always walking someone through the process.), How to open and use Dropbox when someone sends you a shared folder. (business version only).  (Again, this is based on the fact that many of my HCS applicants and sometimes waiver providers have to share documents this way to work on them together or have access to forms for example from anywhere.)

We will also be inviting guest speakers to provide short webinars to providers on resources they might want to access.   Eric Dodd from Taskmaster Pro will be joining us in November for a free webinar and I am working on some of the payroll/hr companies, EVV providers, etc… to also join us as guests.

Additional Training Opportunities


Scope and Severity Webinar Now Available

HHSC is currently offering a webinar to explain scope and severity for providers impacted by House Bill 2025, 85th Texas Legislature, Regular Session, 2017. The training is designed specifically for providers for whom scope and severity is new to the survey process.

Register for the Scope and Severity Training for ALF, DAHS, ICF/IID and PPECC Providers webinar to see available dates and times here.

Please continue to monitor the website for additional dates and times if you are unable to participate during the dates currently being offered. The webinar will be offered on a regular basis for the next few months.

Sept. sessions are full but October 2nd sessions and 2 more on Nov. 6th have opened up..  Register at:

Agency Workforce Management

I found a really nice resource for providers that some of you may or may not be aware of.  MITC Workforce Management Solutions has had some very insightful free webinars on not only their software options for mandated use of EVV (Electronic Visit Verification) systems but also what the switch to an EVV system means for providers (HCS/TxHmL in particular).  There is free state software available, but it may have quite a few gaps for providers and provide the “bare bones” of what your agency needs.  In some cases it may also lead to more complications with tracking time, location, etc.. and that can to loss of revenue, so I urge you to look at other options, even if you do have to spend some money upfront.  There is another free webinar that might be extremely informative on October 17th, 2019.  The presenter is a director out of Louisiana with 20 years of experience using EVV systems.  He will be discussing how agencies can survive the switchover to EVV.  Currently, my understanding is that it will have to be used for the following services (in-home day hab, in-home respite, and CFC.  There is talk of nursing services being added).  If you have concerns about how you are going to bridge payroll/hr services, they do provide payroll integration through Employee Data import along with imports of Time Cards, Payroll Check stubs and W-2’s.  They do work with ADP and many other companies.

For more information and to subscribe to receive alerts about these webinars presented by MITC Workforce Agency Solutions:

Changes to the MWH-IDD Website where TIC Training is Accessed

HHSC Long-term Care Regulatory has issued Provider Letter (PL) 19-08: Trauma-informed Care (TIC) Training to replace PL 16-15. The PL informs providers of changes to the Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities website where TIC training is accessed.

This PL is addressed to Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions providers. Read the details of this PL here.

HCS Survey Review Process, Billing Guideline Changes Summary & Provider User Guide for CARE


Survey Process:  Timelines

By May 1, 2019: Implementation of new WS&C survey process for HCS & TxHmL) (trial period)

Began leaving “Statement of Concern’s” as well as draft at survey exit.

By September 1, 2019: Full implementation of new WS&C survey process for HCS & TxHmL.

Will only leave “statement of concern” at survey exit!

Summary of Billable Guideline Proposed Changes

Please go to the following link for a summary of proposed changes to BG’s from HHSC Presentation April 2019:

We are still waiting on the proposed HCS Billing Guidelines to take effect, that were revealed by HHSC in April of 2019. Not sure when or if these proposed changes are still happening before the end of the year. Clarifications to HCS and TxHmL guidelines for Adaptive Aids including changes to Appendix VI (HCS) and Appendix IV (TxHmL) will be a big part of those changes in the BG’s. Please be looking for those changes very soon!!! 

Here is a direct link to the draft proposed rules from the State of Texas March 2019 archive.

HHSC Provider User Guide (CARE)       

Please go to the following link:


HCS Provider Job Openings & Job Positions Desired

Based on the many phone calls, emails and contacts through our social media pages concerning Job Positions Desired and Job Openings with HCS providers, I have decided to use our “Updates” page to provide a place where both those persons desiring a position with an HCS Provider and those Posting a Job Position can find each other!

We will not be posting the job description or information on this page directly.  If you contact Meghan Jones at and let her know where you are posting a position and who to contact, we can put a link and the contact person’s name, # and/or email.  For example, you are posting on Indeed, Linkedin, BenefitMall, Facebook, PACSTX job postings, an online newspaper, etc…

We will also continue to repost openings when we can on our Linkedin page as well as our Facebook and Instagram pages for Twogether Consulting.

There is no charge, we just ask you all to keep referring us to others who don’t know about us for their HCS business needs and of course we hope you will continue to use our services to assist you with your training needs, on-site and off-site assistance. 

Julie Blacklock/ Owner

Live Classes

Please go to for more information and registration.

There are no live classes posted at this time.  Next live Sessions will be:

” HCS Provider Applicant Prep Session” to be announced in the near future, but most likely as of our last contact with HHSC reps., the orientation and applicant testing will not occur until December of 2019, due to all the changeover in staff and the department at HHSC..

“Care Coordination in the HCS Program” 2-day session in Austin or San Antonio end of August 2019

“Changes to Appendix Q-Immediate Jeopardy for ICF and What That Means For The Provider” 1-day session in Austin end of August 2019


Please remember the following for Payments and Registrations for any classes:


We would be glad to invoice you, so you can pay via credit card, debit card, or paypal account or you may pay by check.  Please indicate how you will paying when you register with Meghan Jones.

You may also pay online by going to our HCS  “About Us” tab and clicking on “payment” tab on the drop down menu.  Or you may click on the direct link to the “payment” page.

Remember to enter in in total $ amount for # of attendees.  Ex:  2 people want to attend x $125 =$250 total. If you have any problems, please ask Meghan Jones to walk you through when you call to register.  Please contact us directly about group rates.


You must contact Meghan Jones at:  to complete registration and for any additional information or to arrange payment by check, you may contact Meghan by phone at: (361) 649-5104
Mailing address for checks: Twogether Consulting P.O. Box 90426 Austin, TX 78709

Person Centered Planning/ Practices

Person Centered Training Opportunities

Person Centered Planning/Practices Training (Hill Country MH/DD Center’s HUB) Person Centered Planning/Practices Training

Good News!!! Free Live Trainings For Person Centered Training are still available from Hill Country MH/DD Centers’ HUB.

They continue to provide free 2-day Person Centered Planning/Practices Training again, so if you have’t met compliance yet with rules and regulations on getting anyone involved with development of the Implementation Plan trained, here is your chance!  They have continued to provide these trainings as of April, 2017. They received funding to start supporting 9 additional people at Hill Country to become Person Centered Thinking trainers. Woo hoo! “

We will keep you posted on new dates for the Person Centered 2-day trainings we receive from Debbie Little Smith/IDD Specialist at Hill Country MHDD Centers.  We are not sure yet about the dates for Sept. and October trainings.

New dates, flyers, and registration links will be available for those of you who are interested as I receive updates. I will post it in our monthly newsletters as well. Please remember this is not being presented by Twogether Consulting, this is a service provided by Hill Country MHDD Centers IDD Training HUB.”

HHSC Person Centered Planning/Practice Training Information

What Training Is Required?

Online Introductory Course

The Texas Health and Human Services Online Introductory Course is appropriate for any member of the planning team, including:

  • Legally authorized representatives
  • Family members
  • Friends
  • Nurses (required in some instances)
  • Behavior specialists (required in some instances)
  • Employment specialists (required in some instances)
  • Attendants (required in some instances)
  • Direct support professionals (required in some instances)
  • Anyone asked to be a member of the planning team

Note: To access and complete this free online training, please go to the HHS Learning Portal, create a user login, and follow instructions to complete the training.


Person-Centered Thinking Classroom Course

To register for the Person-Centered Thinking 2-day classroom course, please go to the HHS Learning Portal, create a user login, and follow instructions to register for a class that is most convenient to your location. Begin Training An introductory course also is offered by DirectCourseOnline. The online offering includes courses in Person-Centered Counseling (PCC) and Person-Centered Thinking and Practice. There are 12 lessons in all.

HHS Approved Full Training

The following training is approved by Texas Health and Human Services for people required to take the full training, specifically case managers, service managers and service coordinators. If you would like to submit a training course to HHS for approval, email: Remember to keep your training certificate.

Our Awesome Admin. Asst.

Meghan Jones

Meghan Jones is our awesome Admin. Assistant, otherwise known as our “Jill of All Trades”.  She handles our registration, keeps up with our enormous provider contact list, our company schedule and calendar, and she is our main point of contact for scheduling, other than myself.  We couldn’t make it without our Meghan!  I know many of you have talked to Meghan over the phone.

You may contact her to complete registrations, set up on-site visits from our consultants, request invoice sent to you directly, or for other questions at:




  Brittany Brown/Medicaid Waiver Program-Payroll Specialist

How can BenefitMall help?

Assistance to HCS/TxHmL/and DH providers with their HR needs as well as payroll. Benefits Mall has some exciting new products for a very low cost that can possibly make a huge difference in ensuring quality assurance with your HR services and needs! Not all payroll companies are created equal. Brittany Brown is our contact at BenefitMall, and she is THE expert in working with Medicaid Waiver Programs.

Information on specific areas with your program that BenefitMall can assist you with.  Please give Brittany a call for more information and assistance:

  • Payroll cash flow issues
  • What does the IRS Tax Code really say about paying host home/foster parents and how can we alleviate some of the anxiety parents experience around their payments
  • Tracking employee time – dealing with employees working multiple division at different rates
  • Labor allocation to help ease the pain with cost reporting
  • Work Opportunity Tax Credits (WOTC)
  • So much more!

Contact Information for Brittany Brown

Mention “Twogether Consulting” when you contact Brittany Brown right now, for a free month of service and a full year of free W-2’s.  

Cell:  832-425-6410          Email:



We Have New Services!

Twogether Consulting has added some new services this year to include:

  • Providing assistance with the development of a ” Nursing Peer Review Process” for your program as well as implementing the “Nursing Peer Review Process” if requested.

If you have 10 or more nurses working for your program (ICF, HCS, TXHmL, etc….), the BON requires the facility to have a “Nursing Peer Review Committee” to review Nursing Infractions and all facilities should have some kind of “Nursing Peer Review Process” in place.

 [NPR §303.0015 ]

“Any person or entity that employs, hires, or contracts for the services of 10 or more nurses (RNs, LVNs or any combination thereof) must have a Peer Review Plan; however, peer review of RNs is not mandatory if the facility employs less than 5 RNs. A person or entity required to have nursing peer review may contract with another entity to conduct nursing peer review.”

 What is Peer Review? [Nursing Peer Review (NPR) §303.001(5)]

Peer review is the evaluation of nursing services, the qualifications of a nurse, the quality of patient care rendered by nurses, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint including:

  1. the evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse;
  2. a report made to a nursing peer review committee concerning an activity under the committee’s review authority;
  3. a report made by a nursing peer review committee to another committee or to the Board as permitted or required by law; and
  4. implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of the committee.

A Peer Review Committee may review the nursing practice of an LVN, RN, or APN (RN with advanced practice authorization).

There are two kinds of nursing peer review:

  1. Incident-based (IBPR), in which case peer review is initiated by a facility, association, school, agency, or any other setting that utilizes the services of nurses; or
  2. Safe Harbor (SHPR), which may be initiated by an LVN, RN or APN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer.

See revised rules 217.19 (Incident-Based Nursing Peer Review and Whistleblower Protections) and 217.20 (Safe Harbor Peer Review and Whistleblower Projections){}


Training now being offered by Twogether Consulting

  • Training (on and off-site) to Providers concerning Direct Care staff’ssurvey interviewer interaction with Surveyors during interviews and how this can affect the provider, particularly the nursing department, as well as preparing for the survey in general.  (HCS, TXHmL, and ICF)
  • Training (on-site) to Providers concerning “Nursing Expectations of Direct Care Staff and It’s Importance”  (HCS, TXHmL, and ICF)
  • Training (on and off-site) to Providers concerning Nursing Staff’s interaction with the Surveyors, particularly during the interview process with the nurse.  (HCS, TXHmL, and ICF)

TASKMASTER PRO “Cloud-Based” Services For HCS, TXHmL, ICF, and CLASS Providers


Discounted Rates Available for Small Providers (20 individuals or less) if you demo with Twogether Consulting to get signed up for TMP! 

As you know, we often provide webinars for providers receiving TaskMaster Pro services and this year some exciting new changes are taking place.  We are having a webinar on January 28th to review some of the new changes added to the nursing component of TaskMaster Pro, which include Comprehensive Nursing Assessment addition.  For those of you who are not receiving TaskMaster Pro currently, we also provide free demos.  Contact us at: or to sign up for demo!

Developed by a provider for providers!

TaskMaster Pro is a web-based cloud computing system designed specifically for managing Waiver and ICF/DD programs. TaskMaster Pro was created by Larry Hill of Hill Resources in Abilene and his team. Through the internet, you will be able to access information and monitor activity from wherever you are and whenever you want and when regulatory changes occur or required forms are updated, TaskMaster Pro is updated so it will never be obsolete. Now this user-friendly, integrated system is available to you.

Request a TaskMaster Pro Demonstration

Manage your program anytime and from anywhere in the world with TaskMaster Pro!

This comprehensive, easy-to-use system has these features:

  •   Secure Communication Center
  •   Program Planning for QMRP’s, Case Managers, and Program Managers
  •   Complete Medical Module
  •   Psychological/Behavioral Module
  •   Service Delivery Log/Billing Waivers
  •   Client Budget
  •   Direct Care Reporting
  •   Incident/Accident Reporting
  •   Scheduling
  •   Report Tracking
  •   Human Resources
  •   Staff Development and Training Module
  •   Time and Attendance
  •   Electronic Data Signature
  •   Off-Site Secure Hosting
  •   Automated File Backup
  •  Customizable Access Control

Whether you have a large, mid-size, small or new start-up company, TaskMaster Pro will work for you!

For a FREE on-line demonstration of how TaskMaster Pro can save you time and money, please contact Julie Blacklock at  512-294-8032 or click on the Request a TaskMaster Pro Demonstration link to sign up.

Please note that before you can receive a demonstration, you must download and complete the Non-disclosure agreement and either fax the form to 512-291-9075 or scan it in and email it back to us available on our website: on the “TaskMaster Pro” page.

ADP Services


For those of you looking for payroll and HR services for your HCS , TXHmL, and ICF Programs, especially in the Houston and surrounding areas, I urge you to contact Laura Throneberry at ADP about these services and more.  She is our contact and works with HCS/TxHmL provider client base in the Austin and Houston area for the most part, and their specific needs.  She does work with providers in other parts of the state as well.

ADP can help you with everything from payroll, to employee handbooks for your company, to tracking items due for your HR files, etc… Whether you are new, small, or large business we could all use some help.  At a time when Providers really need to watch every penny, it is nice to also be informed or updated about changes coming!

Here is some helpful information from them:

90% of all state and federal class or collective actions are wage and hour claims.

Get more info about this statistic here-

This could be EVEN BIGGER thanks to an app released by the DOL (Department of Labor) that allows employees to independently track their time and attendance and compare them to what they are paid! If they find discrepancies they can directly report their employer to the DOL!

With the Return on Investment our employers get just by avoiding these compliance issues…ADP Time Labor Management pays for itself!!! Using time clocks will also help with  upcoming audits for the ACA (Affordable Care Act) that are due OCTOBER 1st for EVERY EMPLOYER NEEDLESS OF EMPLOYEE COUNT!

If you would like more information about our payroll systems, time labor management, and what the Return on Investment looks like for your company, please feel free to reach out to me at any time!


Laura Throneberry at: Office: (512)-795-6764 or Cell:  (713) 517-4715 or you can email her at :