October 26th, 2024
HHSC Publishes Revised PL 2023-01
HHSC has published revised Provider Letter 2023-01 New Regulatory Rules for Long-term Care Regulation (LTCR) Individualized Skills and Socialization Services.
Revisions include information regarding the issuance of temporary initial licenses to applicants for DAHS-Individualized Skills and Socialization Only licensure, clarification on capacity, LTCR surveys, Form 3613-A requirements, emergency response plan requirements, and updates to contact information for TULIP Support.
September 9th, 2024
HHSC Publishes PL 2024-15: Return To Temporary Licensure for DAH’s ISS Only Providers
HHSC has published Provider Letter 2024-15 Temporary Initial Licensure for DAHS-Individualized Skills and Socialization Only Providers.
Beginning September 9th, 2024, HHSC will resume issuing temporary initial licenses to DAHS-Individualized Skills and Socialization Only providers prior to conducting a health survey.
May 5th, 2024
UPDATED ISS FAQ’S
- Pages 18, 21 & 24
- Pages 32, 33, and 36 thru 39
- Pages 41, 57 & 58,
- Pages 63, 68, 71, 73 and 75 thru 80.
HHSC Long-term Care Regulation updated the Individualized Skills and Socialization frequently asked questions document on May 2, 2024.
April 1st, 2024
ISS Administrative Penalties Scope and Severity Grid
Figure: 26 TAC §559.253(b)
| SCOPE AND SEVERITY GRID FOR ADMINISTRATIVE PENALTIES | |||
| ISOLATED | PATTERN | WIDESPREAD | |
| Immediate threat | Substantial=NRTC | Substantial=NRTC | Substantial=NRTC |
| J | K | L | |
| Initial | $400–$600 | $450–$650 | $500–$700 |
| Repeat | $500–$700 | $550–$750 | $600–$800 |
|
Actual harm |
Substantial=NRTC | Substantial=NRTC | Substantial=NRTC |
| G | H | I | |
| Initial | $250–$450 | $300–$500 | $350–$550 |
| Repeat | $350–$550 | $400–$600 | $450–$650 |
|
No actual harm with a potential for more than minimal harm |
Non-Substantial=RTC | Non-Substantial=RTC | Substantial=NRTC |
| D | E | F | |
| Initial | $100–$300 | $150–$350 | $200–$400 |
| Repeat | $200–$400 | $250–$450 | $300–$500 |
|
No actual harm |
Non-Substantial=RTC | Non-Substantial=RTC | Non-Substantial=RTC |
| A | B | C | |
| Initial | $0–$0 | $0–$0 | $0–$0 |
| Repeat | $0–$0 | $0–$0 | $0–$0 |
March 18th, 2024
New Rules For ISS
PL-2023-01(Revised)
https://www.hhs.texas.gov/sites/default/files/documents/pl2023-01.pdf
March 7th, 2024
HHSC Hold Harmless Period Ending
This “hold harmless” period is ending for ISS providers on March 17, 2024.
Beginning March 18, 2024, HHSC will survey for compliance with all regulatory requirements, including off-site provision of services, and move forward with applicable enforcement actions as outlined in Title 26 Chapter 559, Subchapter H, Division 4 (Survey, Investigations & Enforcement)
Draft Amendments to ISS Licensing Rules
February 14th, 2024
Delays In Receiving ISS Licenses
December 15th, 2023
Clarification on Licensure Renewals
All licensed long-term care providers must submit a renewal application in the Texas Unified Licensure Information Portal (TULIP) before their current license expires. While a re-licensure/recertification survey is part of the renewal process, it doesn’t take the place of submitting a renewal application in TULIP.
HHSC encourages providers to submit the application as soon as possible within the 120 days prior to the expiration of their license, so that if there are issues with TULIP — such as the renewal application not being in the TULIP account — the provider has time to work with TULIP Support prior to their license expiring.
If the provider is waiting on pending documentation — such as a current fire marshal report — it’s better to go ahead and submit the renewal application with the deficiency and upload a letter explaining why they don’t have the required documentation.
***If the application isn’t submitted before the license expires, the provider risks providing services without a license. This is only for licensed LTC providers. Does not include HCS/TxHmL providers as they are contracted, not licensed.
December 14th, 2023
ISS UPDATE WEBINAR DECEMBER of 2023
Please review webinar handout for changes to the Implementation Plan and Person-Directed Plan for ISS.
*PDP’s need to reflect type of ISS (In-Home, On-Site, Off-Site) and activities and schedule.
*IP’s need to also reflect type and objectives for type as well as hourly amount and dollar amount for each type of ISS.
August 18th, 2023
Transition to Individualized Skills and Socialization Survey Deadline Extended
HHSC implemented individualized skills and socialization services in the Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) Medicaid 1915(c) waiver programs, effective Jan. 1, 2023.
HHSC is requesting feedback from HCS and TxHmL program providers only on the impact this change has had on individuals receiving services in the form of a short survey.
Take the survey to provide your feedback.
We thank you for your input. HHSC is extending the deadline to submit responses until Aug. 31, 2023.
All HCS and TxHmL program providers who have not submitted a response must complete the survey by this deadline. Providers who have already completed the survey do not need to submit an additional response.
July 17th, 2023
HHSC Updated the Individualized Skills and Socialization Hold Harmless Period through March 17th, 2024
On Jan. 1, 2023, HHSC implemented the DAHS Individualized Skills and Socialization program and offered an initial hold harmless period from Jan. 1, 2023, through June 30, 2023.
HHSC agreed to extend part of the hold harmless period related to the provision of off-site services.
HHSC will survey for compliance with off-site service delivery but will not move forward with enforcement action.
For all other regulatory requirements, beginning July 1, 2023, HHSC will survey for compliance and move forward with applicable enforcement actions as outlined in Title 26 Chapter 559, Subchapter H, Division 4.
The new hold harmless period related to the provision of off-site Individualized Skills and Socialization services begins July 1, 2023, and ends March 17, 2024.
March 28th, 2023
Host Home Companion Care Providers Concerning ISS & PHE Flexibilities For In-Home ISS
Clarification Concerning Information Letter No. 2023-10 (Replaces IL 2023-06) from February 2023
In-Home Individualized Skills and Socialization Information for Program Providers for COVID-19 PHE
In response to COVID-19 and to provide access to day habilitation services, the Health and Human Services Commission (HHSC) temporarily waived certain requirements in Sections 3710, 4381.3, 4381.7(6) and 4381.7(7) of the HCS Billing Requirements and the TxHmL Billing Requirements. Until the end of the COVID-19 PHE, this flexibility will continue as part of in-home individualized skills and socialization.
Effective May 12, 2023, these flexibilities will no longer be in effect:
The flexibility has allowed HCS and TxHmL program providers to provide in-home individualized skills and socialization to an individual in the individual’s residence, including those residing in their own homes or family homes, without having the required justification outlined below. Program providers and LIDDAs need to have transition plans ready for individuals who receive in-home individualized skills and socialization prior to this end date (before May 12th, 2023).
Beginning May 12th, 2023:
in order to receive in-home individualized skills and socialization, individuals must meet all requirements outlined in the HCS and TxHmL Program Rules, the HCS Billing Requirements, and the TxHmL Billing Requirements, which include:
• A physician has documented that the individual’s medical condition justifies the provision of in-home individualized skills and socialization; or
• A licensed professional or behavioral support service provider has documented that the individual’s behavioral issues justify the provision of in-home individualized skills and socialization; or
• The individual is 55 years of age or older and requests to receive in-home individualized skills and socialization.
In addition, after May 11, 2023, a service provider of host home/companion care will not be permitted to provide in-home individualized skills and socialization to the individual to whom they provide host home/companion care services.
Clarification & Answer to Question From Some of Our Readers:
This letter indicates that HHSC does not appear to prevent a host home provider from becoming an ISS provider, nor does it prevent that licensed ISS provider from providing on-site and/or off-site services to their own individuals living with them. In other words, it would appear they can be a HH/CC provider and licensed ISS provider at the same time and they can provide ISS services to their own individuals they are serving as HH/CC providers. They can not provide their own in-home ISS (anymore) as an HH/CC provider as of May 12th, 2023. The only ISS they can provide after May 11th, is if they are a licensed on-site and/or off-site provider.
March 1st, 2023
Reminder Must Be Licensed As ISS Provider To Bill As Of March 1st, 2023
For HCS/TxHmL Providers, you can’t bill for On-site &/or Off-site ISS as of today March 1st, 2023, if you send someone to an ISS location or have staff providing Off-site services (previously Community DH), if they are not listed as a licensed ISS program.
The directories may be accessed at: https://www.hhs.texas.gov/providers/long-term-care-providers/day-activity-health-services-dahs to find out if the ISS program is licensed.
**You can bill for In-Home ISS as persons providing In-Home ISS do not have to be licensed! No justification is needed for In-Home through May 11th, 2023 I believe. I believe HH/CC providers can still provide In-Home (This was part of the PHE exception prior to March 1st) up through May 11th, 2023, but I am still unclear and will inquire and update everyone when I get some kind of definitive answer.
Previous DH providers & New ISS Provider applicants: If you do not have a temporary ISS license by March 1, 2023, you may not provide or bill HCS, TxHmL, or DBMD providers for on- and off-site ISS services until the temporary license is received. HCS/TxHmL, DBMD Providers who have individuals attending an ISS program may not send persons to the program until they confirm that the operator of the program has received the license. There are no exceptions.
February 21st, 2023
More ISS Training
Very Important: Surveys of ISS Providers With Temporary Licenses
In case this information was overlooked by new ISS providers:
- Once HHSC issues a temporary license, HHSC may conduct a survey at any time.
- HHSC may conduct a survey of any licensed Individualized Skills and Socialization Providers prior to March 1, 2023.
- i.e. if HHSC issues a temporary license on Feb. 21, 2023, HHSC may conduct an initial survey on Feb. 27, 2023.
- HHSC conducts unannounced surveys of ISS Providers.
- For on-site ISS providers, the address on the license must match the address for service provision.
- ISS providers must allow HHSC surveyors access to the on-site location and off-site activity locations.
Please refer to Texas Administrative Code Title 26, Chapter 559 for more info on the LTCR survey process.
February 10th, 2023
How Do I Find A Licensed ISS Provider?
HHSC has now posted directories on the DAHS webpage to help people find a licensed ISS Provider.
The directories may be accessed at: https://www.hhs.texas.gov/providers/long-term-care-providers/day-activity-health-services-dahs
Please note the following:
- There are 2 directories: DAHS with ISS and DAHS-ISS Only.
- The DAHS with ISS Directory is intended to reflect entities licensed as just a DAHS, and entities licensed as DAHS with ISS.
- At this time, this particular directory lists all entities as just having a DAHS license. This is because the commission has yet to approve any DAHS with ISS licenses. The process for approving a DAHS with ISS application takes longer than that of a provider applying as an ISS-only entity. According to HHSC, the entity must undergo an LSC and Health survey before a license is issued to a DAHS with ISS entity. Once these have been approved, they will be listed in this directory as DAHS with ISS.
- Entities listed in the DAHS – ISS Only Directory, currently reflect a 6-month license. This is because these licenses are considered ‘temporary’ at this time. Once the health survey is conducted the entities will receive a one, two or three-year license.
February 5th, 2023
HHSC LTCR Updates the ISS FAQ’s
HHSC Long-term Care Regulation updated the Individualized Skills and Socialization frequently asked questions document on Feb. 01, 2023.
January 27th, 2023
FYI- somehow I missed this alert back in November for Licensed ISS providers. Please be sure to log in and set up your account.
PL 22-32 letter issued 11/28/22 to ISS providers that was sent out concerning Blackboard Connect Emergency System
The purpose of this letter was to inform providers of the emergency communication system called Blackboard Connect, how it will be used, and your responsibility in signing up for the system if you are an ISS provider. This system will be used to send emergency and outreach notifications through email, phone, voice and text if available.
The rules require program providers to assign a designee to enroll in and respond to requests through the system. The designee should be someone who is associated with the licensed building or someone who is responsible for communicating emergency communications. However, you may also have other designees, such as corporate headquarters staff, sign up.
Blackboard Connect sign-up process:
Go to this link and click “Sign Me Up!”
If you have any questions, please contact the Policy and Rules Section by email at LTCRPolicy@hhs.texas.gov or call (512) 438-3161.
Rember, this also applies to HCS, TxHmL and ICF providers among other services.
January 16th, 2023
- The ‘new’ IPC referenced in IL 2022-03 will most likely not be ready until March. They did not have answers as to what providers should do in the interim or even how service logs should be revised until new ones are available. (The letter does indicate that those individuals receiving DH at the time of the switch to ISS (March 1st, 2023) will initially roll over automatically to ISS ).
- After Feb. 28th this would apply to all current clients as far as IPC units are concerned. Persons who don’t have any Day Hab units/days on their plan as of Feb. 28th, 2023 and want ISS hours, will have to do a new PDP and request IPC hours. Providers will have a new IPC form, with ISS on it, before March 1st, 2023.
- To date, no provider has been issued an ISS license.
- Providers can confirm that an entity has an ISS license by checking the DAHS directory on the DAHS webpage: https://www.hhs.texas.gov/providers/long-term-care-providers/day-activity-health-services-dahs
ISS FAQs and Upcoming Webinars:
On January 26, 2023, from 9:00 to 10:30 HHSC will conduct its quarterly LTC webinar which will focus on ISS. To register for the webinar, go to: https://register.gotowebinar.com/register/5204373791714060639
January 12th, 2023
Information Letter No. 2023-03 Individualized Skills and Socialization Automatic Service Authorizations
Effective January 1, 2023, individualized skills and socialization became an available service in the HCS and TxHmL Programs. For the time period of January 1, 2023 to February 28, 2023 both day habilitation and individualized skills and socialization will be allowable program services.
Day habilitation will no longer be a Medicaid-billable service in the HCS or TxHmL Programs for dates of service beginning March 1, 2023, and ongoing.
On January 9, 2023, HHSC will automatically add units of individualized skills and socialization for all individuals with day habilitation (including individuals receiving in-home day habilitation through the COVID-19 flexibility) currently authorized on their individual plan of care (IPC). The units will be available for billing immediately for the provision of on-site, off-site, or in-home individualized skills and socialization and will be visible to program providers in the Medicaid Eligibility Service Authorization Verification (MESAV). The added units will be authorized beginning January 1, 2023 through the end of the individual’s current IPC period. For individuals with an IPC period that must be renewed between January 1, 2023 – April 30, 2023, the added units will be authorized until December 31, 2023.
These units for individualized skills and socialization will not be visible to program providers or service coordinators on the IPC in the Long-term Care Online Portal (LTCOP) on the Texas Medicaid & Healthcare Partnership (TMHP) website nor on the dashboard until a revision or renewal IPC is entered. This automatic service authorization will give service coordinators additional time to meet with the individual’s service planning team (SPT) to update the individual’s person-directed plan (PDP) and for program providers to update the individual’s implementation plan (IP) as this new service takes effect. HHSC is implementing this process to minimize disruption to an individual’s desired services.
Service Plan Revisions
At the individual’s next service planning team meeting to complete a revision or renewal IPC (whichever occurs first) for individuals receiving individualized skills and socialization, service coordinators should update the individual’s PDP to reflect the new individualized skills and socialization service. During the service planning team meeting, any new goals related to the provision of on-site and off-site individualized skills and socialization should be discussed and documented in the new action plan. Until the PDP is updated, the individual’s current day habilitation goals, frequency, and duration should be followed for the individualized skills and socialization service.
Following the update to the PDP, the IPC and IP must be updated in accordance with applicable HCS or TxHmL Program rules with the appropriate units of individualized skills and socialization. HHSC will update the IPC and IP form to add individualized skills and socialization by March 1, 2023.
All individual’s PDPs, IPCs, and IPs must be updated with the appropriate units of individualized skills and socialization in accordance with applicable HCS or TxHmL Program rules by December 31, 2023.
For new enrollees and current enrollees who are not currently receiving day habilitation, individualized skills and socialization will need to be added, once the IPC and IP form have been updated, to the individual’s service plan because units will not be auto-authorized for these individuals. Day habilitation can be added and delivered until February 28, 2023.
To read more, please click on link below, for Information Letter 2023-03 related to ISS automatic service authorizations and EVV
January 3rd, 2023
Easier Format For ISS Licensing Rules effective Jan. 1, 2023
The link below provides a format that is easier to read and understand the newly adopted licensing rules rather than those when published as adopted in the Texas Register
Effective Jan. 1, 2023, HHSC adopts new Individualized Skills and Socialization rules for providers who want to deliver individualized skills and socialization services. New rules provide guidance regarding:
- applying for an Individualized Skills and Socialization license;
- provider requirements; and
- HHSC survey and enforcement actions.
Read the new rules in Title 26 of the Texas Administrative Code, Chapter 559, Subchapter H.
HHSC also published Provider Letter 2023-01 New Regulatory Rules for Long-term Care Regulation (LTCR) Individualized Skills and Socialization Services. This PL provides guidance to Individualized Skills and Socialization providers about the new rules.
Read PL 2023-01.
December 23rd, 2022
NEW RULES FOR ISS & ISS LICENSE
HHSC Adds Individualized Skills and Socialization to Email and Text Updates
HHSC added an option to the HHSC email and text update GovDelivery system that subscribers can select to receive updates related to the Individualized Skills and Socialization services program. Users can select to receive Individualized Skills and Socialization program alerts from the “Provider Alerts” drop-down menu.
To sign up for updates, select this link Texas Health and Human Services Commission (govdelivery.com).
For questions about Individualized Skills and Socialization, please email LTCRPolicy@hhs.texas.
November 28th, 2022
Webinar for New Licensing Process Nov. 30th, 2022 Extended to 2 hrs
All providers interested in the new licensing process for the Day Activity Health Services Individualized Skills and Socialization program are invited to a 2-hour webinar on Nov. 30. Originally it was a 1 hr session but has now been extended to have enough time for questions and explanations.
HHSC Long-Term Regulation staff will discuss how to navigate TULIP, the licensing system, explain the license application process and provide an overview of the survey process. There will also be a Q&A session as time allows.
Register for the webinar: Licensing Process Webinar
November 19th, 2022
DAHS ISS Licensing Application Available!
On Dec. 1, 2022, HHSC will launch the Day Activity Health Services (DAHS) Individualized Skills and Socialization License Application in the Texas Unified Licensure Information Portal (TULIP).
Link to TULIP: https://txhhs.force.com/TULIP/s/
Email TULIP_Support@hhsc.state.tx.us with questions related to TULIP functionality or if you have issues gaining access.
Email LTC_NF_DAHS_Licensing@hhs.texas.gov with questions related to the DAHS Individualized Skills and Socialization licensing application
October 13th, 2022
Licensing Application Process For ISS:
October 2nd, 2022
Register for Individualized Skills and Socialization Provider Portal Trainings
Individualized Skills and Socialization Provider applicants are required to complete HHSC Individualized Skills and Socialization Provider Trainings. Below are two computer-based trainings, which will assist Individualized Skills and Socialization Providers with applying for a license and preparing for an inspection.
- Prelicensure Training for Individualized Skills and Socialization Providers
This training was designed for providers who wish to offer individualized skills and socialization services. Prior to surveys or inspection, an entity must submit an application for a Day Activity and Health Services license. Information about the requirements to obtain a license will be shared. Register for the training. - Preparing for an Inspection
This training was designed to assist Individualized Skills and Socialization Providers to prepare for an inspection. In this course, information about the inspection process and licensure rules will be shared. Register for the training.
September 24th, 2022
HHSC Moved The Individualized Skills and Socialization Webpage
The Individualized Skills and Socialization webpage moved from the Resources webpage to the main Long-term Care Providers webpage. This was done so its location is consistent with other Long-term Care Regulation programs and is easier to find.
Individualized Skills and Socialization can be found under the “Community-based Programs” heading.
August 23rd, 2022
No Public Hearing on ISS Licensing Rules
Comments must be submitted no later than 31 days after the date the rules were published in the Texas Register; i.e., 31 days after August 12, 2022.. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate “Comments on Proposed Rule 22R050” in the subject line.
Public Hearing on ISS Program Rules
HHSC will conduct a public hearing on the proposed HCS, TxHmL and DBMD ISS program rules on September 7, 2022 from 8:00 am. until Noon. To register for the virtual hearing, go to: https://attendee.gotowebinar.com/register/927810115195515152
For a copy of the proposed ISS license rules or go to: https://www.hhs.texas.gov/regulations/policies-rules/health-human-services-rulemaking/comment-proposed-draft-rules
August 13th, 2022
Texas HHSC has developed the Individualized Skills and Socialization Provider Portal, an online source of information for providers of individualized skills and socialization.
The Individualized Skills and Socialization Provider Portal will allow providers to:
- Complete and review trainings on the Individualized Skills and Socialization service.
- Find and review provider letters and other information and releases related to Individualized Skills Socialization.
- Link to rules and other services related to Individualized Skills and Socialization.
Provider Communications
- PL 2021-42 – This Provider Letter offers a brief introduction to the new individualized skills and socialization service and what providers can expect as HHSC implements the service.
- Individualized Skills and Socialization Services webinar – This helpful webinar provides an introduction and overview to Individualized Skills and Socialization
- Individualized Skills and Socialization FAQs – revised April 26, 2022
- July 2022 – Individualized Skills and Socialization Provider Webinar – This webinar covers the service description, ratio requirements, and licensing information based on HHSC’s draft individualized skills and socialization rules.
August 6th, 2022
See Draft/Proposed Rules for ISS in HCS and TxHmL below:
Proposed ISS Rules (Main portion of rules start on page 13-52)
- The anticipated adoption date is October, 2022 with an effective date of November 2022. These dates also apply to the proposed rules for the DBMD waiver program.
- Very few changes were made from comments HHSC received during the informal comment period earlier this year. Though we had been apprised of such before this positing, know that any comments you submitted during the informal comment period will need to be resubmitted.
- Carefully review the introduction to the HCS and TxHmL rules on pages 1 -4, including the sections on Issues and Alternatives and Stakeholder Involvement on page 3.
- Carefully review the preamble to the rules before reading the actual rules and pay attention to the sections on Impact to Small Businesses.
- The proposed HCS and TxHmL rules are included in one document. To help you navigate the document, the following is offered:
