ISS Rates

by | Jan 11, 2023

January 11th, 2023

 Revised Information Letter (IL) 2023-01 related to ISS Payment Rates (replaces IL 2022-56):  

HHSC has published Revised Information Letter (IL) 2023-01, which replaces 2022-56 related to payment rates for Individualized Skills and Socialization Services, effective January 1, 2023.

HHSC has also approved payment rates for the Individualized Skills and Socialization in the Deaf Blind with Multiple Disabilities waiver (DBMD), Home and Community-based Services waiver (HCS), and Texas Home Living waiver (TxHmL) programs, effective January 1, 2023.

Contact PFD-LTSS@hhs.texas.gov or (737) 867-7817 if you have questions.

HCS Rates Jan. 1st, 2023 including ISS services

December 06, 2022

Last Friday HHSC posted the ISS rates which may be viewed at the link below.

https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2023/2023-01-hcs-rates.pdf
Please remember the following:
  • The on and off-site ISS rates are effective January 1, 2023. It appears to be unlikely any of the licenses for ISS will be approved by that time.
  • The current in and out-of home DH rates will remain effective through February 28, 2023.
  • ACRE will not be available for the ISS service.
  • This is because the current DH rate is a daily rate; the ISS rate is an hourly rate. 
  • Restructuring this component of ACRE will necessitate additional funds which HHSC will be requesting from the 88th Texas Legislature. Unfortunately, once received access to funds will not be available until September 1, 2023 and which providers choosing to participate in ACRE can request during the July, 2023 enrollment period.
  • Though the ISS rules have yet to be adopted (hopefully by no later than December 16th), the proposed rules allow persons with a medical or behavioral justification to receive in-home ISS.
  • proposed rules also state that if requested, a person who is 55 or older may also receive in-home ISS. 
  •  The provider of the in-home ISS service does not need to be a licensed ISS provider.
  • Note:  As proposed, the rules do not address whether persons with the aforementioned justification or request can also participate in community activities and bill for off-site ISS.  Though assumed this will not be permitted, we are still waiting for a response.
  • The off-site rates allow for two levels of enhanced staffing.  Though the proposed rules did not call for two levels of enhanced staffing, the adopted rules will.
  • The adopted rules will also change the ratios at least for the ‘LON 1 and LON 5 without enhanced staffing’ category.

September 27th, 2022

Please see the newly proposed ISS (Individualized Skills & Socialization) rates.  The proposed rates would be effective January 1st, 2023, if accepted, at the following link:  https://pfd.hhs.texas.gov/sites/rad/files/documents/2023/01-01-2023-pmnt-rates-individualized-skills-socialization-%20srvcs.pdf

Hearing:
The Texas Health and Human Services Commission (HHSC) will conduct an in-person public hearing to receive public comment on proposed Medicaid payment rates from 9:00 a.m. to 11:00 a.m. on October 11, 2022. The public hearing will be held in the Robert D. Moreton Building, Public Hearing Room M-100, First Floor, at 1100 West 49th Street, Austin, Texas 78751. Free parking is available in front of the building and in the adjacent parking garage. HHSC will consider feedback shared during the hearing prior to final rate approval. The hearing will be held in compliance with Texas Human Resources Code Section 32.0282, which requires public notice of hearings on proposed Medicaid reimbursements.
Should you have any questions regarding the information in this document, please contact: Provider Finance Department Long-Term Services and Supports Texas Health and Human Services Commission
E-mail: PFD-LTSS@hhs.texas.govHHSC will archive the recorded public hearing.

The recording can be accessed on-demand after the hearing at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings.

For HCS/TxHmL programs, HHSC is proposing rates that will vary by an individual’s Level of Need (LON). HHSC is also proposing a Level One Enhanced Staffing Rate and Level Two Enhanced Staffing Rate for off-site individualized skills and socialization. The Level One Enhanced Staffing Rate for off-site individualized skills and socialization is for certain individuals with LON 1 or LON 5 who need additional supports while in the community. The Level Two Enhanced Staffing Rate is for certain individuals with a LON 1, LON 5, LON 8, or LON 6 in the HCS Program, and any individual in the TxHmL Program regardless of LON who need additional staffing supports than supported by the Level One Enhanced Staffing Rate off-site for individualized skills and socialization.
*All proposed individualized skills and socialization rates are per hour.