Twogether Updates

December 1st, 2023 ICF/IID Providers: Implementation of the Personal Needs Allowance (PNA) Adjustment As required by House Bill 54 (88th Legislature, Regular Session, 2023), the Health and Human Services Commission (HHSC) is directed to increase the minimum monthly personal needs allowance (PNA) for Medicaid beneficiaries of a nursing facility (NF) or related institution licensed under Chapter 242, Health and Safety Code, assisted living facility, intermediate care facility for individuals...

December 1st, 2023 As of Nov. 14, 2023, service coordinators and case managers in the CLASS, DBMD, HCS, TxHmL waiver programs and STAR+PLUS Home and Community-Based Services (HCBS) must use the Employment First Discovery Tool as part of the service planning process to explore an individual’s desire to work. Review IL 2023-41 Employment First Discovery Tool for more information. Be sure to sign up for : Employment First Discover Tool Webinar Jan. 10, 2024 10–11 a.m. Register here to attend the...

November 25th, 2023 I am happy to announce that I was presented with the Dr. Ollie Seay Knowledge Award For Excellence In Education or Research.  I was so honored to receive this award especially since I first met Dr. Seay when I first started working with IDD services at Austin Travis County MHMR (Now Austin Integral Care) in 1992 when she was head of the psychology department at our offices.  We lost Dr. Seay earlier this year and she will be missed by all who knew her, especially for her...

November 12th, 2023 Texas HHS Aging Services Coordinationor will be presenting a webinar series during National Family Caregivers Month in November. This webinar series is for caregivers, people who work with caregivers and anyone interested in caregiving. November Caregiver Webinar Series November 15, noon-1 p.m. Cultivating Community and Support for the Lifespan: Caregiving for Children with Disabilities Register here. November 29, noon-1 p.m. Overview of supports for caregivers and care...

November 11th, 2023   I thought this was a great article for providers and their DSP's.  Please feel free to check out their other articles and resources and their training on person-centered practices! Clinical Pearls in IDD Healthcare that are Important Knowledge for DSPs As co-published by National Alliance for Direct Support Professionals (NADSP) and Research and Training Center on Community Living (RTC-CL) in the Frontline Initiative. By Craig Escudé, MD, FAAFP, FAADM, President of...

November 11th, 2023   The Texas Health and Human Services Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP), and HHAeXchange will have one last Town Hall webinar for all Electronic Visit Verification (EVV) stakeholders. Attendees will have the opportunity to ask questions and provide input on the Texas EVV migration to HHAeXchange and the upcoming EVV expansion due to the Cures Act Home Health Care Services implementation. Webinar Registration Register ASAP!  If you...

Q&A's For EVV HAAeXchange Contact Information Guide For Program Providers & FMSA's Client Support Portal Information Contact Information Guide For CDS Employers EVV Mailbox – evv@hhs.texas.gov

November 10th, 2023 From our friends at IntellectAbility. Apologies, just wanted to remind you all of this wonderful tool they created, that many providers asked me about in the past (Mostly nurses, lol).  Previously this tool was under a different company name.  There was a change sometime back in the name of the company.    For those of you who want to learn more about IntellectAbility's health risk mitigation tools and training by visiting ReplacingRisk.com.  Feel free to call us at...

November 8th, 2023 Just A Reminder (As of 10/11/23) Concerning IPC Renewals Due to the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) rate changes effective September 1, 2023, providers and local intellectual and developmental disability authorities (LIDDAs) are advised to use the Submit Form option on Individual Plan of Care (IPC) renewals. When to Use Submit Form Instead of Use as Template Use Submit Form instead of Use as Template under these conditions: There have...

November 2nd, 2023 HHSC Now Posting EVV Known Issues and Resolutions Vol. 1 (Last updated on 10/18/2023) The Texas Medicaid & Healthcare Partnership (TMHP) has recently received feedback from Electronic Visit Verification (EVV) program providers and financial management services agencies (FMSAs) about ways to enhance their user experience of the HHAeXchange system. The topics listed in this article highlight the most frequently occurring issues that EVV users have identified as areas in...

October 30th, 2023 Update From Twogether Consulting! Hope you all are well. Happy Halloween! Here is the update on what is going on with Twogether Consulting     For HCS Providers who want to purchase the quarterly on-site review checklist for Host Homes and for site reviews in general, you can now purchase the form at the following link on our website: "purchase services" page. If you are having issues with the download, please contact us at info@twogetherconsulting.com and I will be happy to...

October 22, 2023 On-Site Residential Inspection Form HCS Providers- I was finally able to get the Twogether Consulting website updated to include this new product on our "purchase services" page. We have our new on-site residential inspection form that can be used for Group Homes & Host Homes at initial inspection, annual renewal or when an individual moves to a new residence. Most importantly, it can also be used for the new mandatory quarterly inspections for your host homes that are...

October 15th, 2023 Nurse Aides (NAs), Medication Aides (MAs), Nursing Facility Administrators (NFAs), and Nurse Aide Training Competency Evaluation Programs (NATCEPs) are now required to use the new credentialing system in the Texas Unified Licensure Information Portal (TULIP) for licensing certification or permitting activities. Note: HHSC is extending a grace period for all NAs, MAs, NFAs and NATCEPs to allow users time to learn and understand the new credentialing system. All NAs...

October 17th, 2023 COVID-19 Resources COVID-19 Quick Reference (New Guidance) From our friends at PharMerica, please go to the following link to get your free and current quick reference guide for Covid-19    July 11th, 2022 July 7, 2022 MCS COVID-19 Stakeholder Information Session Thank you for your interest in listening to the July 7 Texas Medicaid CHIP COVID-19 Information Session. The audio from this session can be found here. Email us for transcript The presentation can be found...

September 29th,  2023 Update From Twogether Consulting! Hope you all are well!  Just wanted to update you on what is going on with Twogether Consulting I would like to reiterate again this newsletter, that there are new TAC codes for HCS under Title 26 Part I  Ch.263 and  Ch. 565.  Ch 565 went into effect June 21st, 2023 and the Certification Principles are now listed as Certification "Standards" in Ch 565. Again, please be sure that providers gather their administrative staff including case...

  September 29th, 2023 HCS and TxHmL Waiver Programs: Trending Issue Support, Volumes 21-24   HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 24 HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 23 HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 22 HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 21 HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 20 Since May 2, 2022, Home and Community-based Services and Texas Home...

September 28th, 2023 On September 28, 2023, the Meaningful Skills Development and  Employment Services subcommittee of the IDD System Redesign Advisory Committee will meet at 1:00 p.m.  Members are encouraged to listen to the meeting which is accessible via webcast.   To view the agenda and link to access the meeting go...

September 28th, 2023 Beginning December 2024 a third TMHP contract for Claims Processing and Adjudication and Financial Services (Claims) with Conduent State Healthcare, LLC(Conduent) will be implemented. The TMHP Claims vendor will perform fee-for-service claim processing and fiscal agent responsibilities such as claim payment and recovery of overpayments. TMHP claims processing will continue as-is until the new TMHP Claims contract is fully implemented in December 2024. Remember, if you...

September 13th, 2023 Home and Community-based Services (HCS)   Provider Letters/Provider Communications!!! Click here for news, information letters (ILs) & provider letters (PLs). Receive Emails from HHS Every Sunday The Texas Health and Human Services Commission contracts with a company called Granicus to provide email updates, called GovDelivery. In accordance with your contract, and contracting rules at 40 Texas Administrative Code §49.302(g), you must subscribe to receive HHSC...

September 4th, 2023 VERY IMPORTANT:  Provider Enrollment Revalidation Requirements Provider Enrollment Revalidation Requirements  https://www.tmhp.com/news/2023-09-01-reminder-provider-enrollment-revalidation-requirements Providers must complete their revalidation enrollment before the end of their enrollment period. Providers can revalidate their enrollment in the Provider Enrollment and Management System (PEMS) up to 120 calendar days before their current revalidation due date. Providers who...

September 5th, 2023 As of Sept. 5th, TMHP had implemented improvements to the phone system, including the Automated Inquiry System (AIS). Here are some of the improvements: A. Some of the menu options and messages have changed. B.TMHP is adding direct transfers where applicable. The new system has the ability to recognize menu options through touch-tone keypad selection or speech recognition to engage callers. For more information call the TMHP help desk at 800-626-4117   LONG Term Care...

August 24th, 2023 Here are the rates effective Sept. 1st, 2023 for the following programs HCS:  https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2023/2023-09-hcs-rates.pdf ICF/IID:  https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2023/2020-09-icf-rates.pdf TxHmL:  https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2023/2023-09-txhml-rates.pdf...

August 24th, 2023 Overview of the new HCS survey process  See (PL) 2023-09 below FYI, the letter from HHSC does not provide all the details about the survey process and does not address the provider-required HH quarterly visits and related expectations. Providers may still have many questions and we urge you to contact your provider associations.  You can also feel free to contact us at: info@twogetherconsulting.com or javasbja@gmail.com and I will be happy to pass them on.  As a reminder, the...

August 23rd, 2023 Person-Centered Training Opportunities Our good friend at IntellectAbility, Patrick Lane has provided a link where providers or anyone else interested can register for online Person-Centered Thinking training.  FYI-this is a requirement in the HCS/TxHmLTAC rules for all persons who are a part of the development of the Implementation Plan (IP), to have this training within the first 2 year of hire. Staff Member and Service Provider Requirements The session is a $275 per...

Get Your Promotions for Becoming A New ADP Client:  - 1st  3 months free   - Other Discounts Available! *Please Let ADP know how you found out about their services to get your 1st 3 months free!   August 21st, 2023 Twogether Consulting strives to find a variety of good resources for our IDD providers and hope that ADP may be able to help some of you out there with Payroll and HR needs. Our newest contact from ADP is, Sophia Luna. She is the Small Business Consultant For Central Texas. ...

August 19th, 2023 Exception Extended to August 31st, 2024 In March 2020, HHSC started a temporary policy change for respite and Community First Choice (CFC) Personal Assistance Services (PAS)/Habilitation (HAB) provided in the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs. This change allows service providers of respite and CFC PAS/HAB to live in the same home as the person receiving these services. A person’s spouse, or parent if the person is under 18,...

August 16th, 2023  ISS Survey From July 2023: HHSC posted a survey (9 questions) asking comprehensive service providers to complete.  The survey is intended to gather information about ISS network adequacy and to determine what, if any changes, are needed.   CMS  is hoping to use the data to find out how the transition is going. HHSC stated that it only received 262 responses, some were incomplete, and some were completed by an ISS only (independent ISS) provider. Action Needed:  HHSC is...

August 15th, 2023 Remediation & Validation Process  This is a process of performing on-site visits to determine compliance by ISS providers, with certain HCBS Settings rules and other rules:   HHSC reviewed the process and the assessment tool being used.  Here is the information letter sent out previously. IL-2023-28  https://www.hhs.texas.gov/sites/default/files/documents/il2023-28.pdf Please note the information about the required attestation form that must be completed by all ISS...

August, 15th, 2023 Compliance with new rules in Ch 565 on additional oversight for HH/CC service providers & Individuals receiving services Concerning the now required quarterly HH/CC On-site Visits to review specific areas that providers must conduct, providers have expressed concerns about HH/CC service providers being very upset with this new change of more oversight by the provider and HHSC, and they have concerns that it will be too intrusive. There are also concerns that this will be...

July 31st, 2023 Just wanted to post some helpful tips for all of the new ISS providers out there.  #1. Be sure you date your ISS policies, and specifically for any Evacuation &/or Emergency Response Procedures  When you revise them, show the revision dates on those policies. ISS Service Providers can receive a violation from the survey team for not doing so. #2. Be sure to get with your local emergency response coordinators in your areas, to help you with developing your Evac/ER Response...

July 25th, 2023 Please click on the link below to register for the Caregiver Webinar Series from HSC HHSC Caregiver Webinar Series Starts August 16

July 6th, 2023 If you need some help with training your On-Site and Off-Site ISS staff on Abuse, Neglect, and Exploitation, Twogether Consulting has developed a short 45 min-1hr training to address everyone from direct support staff at your ISS to your Administrator. Included are but not limited to: definitions of Abuse (Physical, Mental, and Sexual), Neglect, Exploitation, and Mistreatment as well as signs and symptoms of each one of these. This session also discusses who to report to, CII...

June 20th, 2023 TxHmL & CFC Certification Standards Adopted  As of June 21st, 2023 the new HCS & CFC Standards will be effective. These rules were transferred from Chapter 9 to Chapter 566, including both newly added rules (Ch. 262) and rules from Chapter 9  which have been revised to ensure clarity.  HHSC intends to post an Information Letter regarding the rules which will review each section of the rules in the document we have included below, as well as, those rules which have been...

June 26th, 2023 EVV Policies Policy Handbook EVV Policy Handbook Policy Handbook Revision Log Jan. 6, 2023, revisions (PDF) Sept. 1, 2022, revisions (PDF) June 1, 2022, revisions (PDF) March 1, 2022, revisions (PDF) Jan. 7, 2022, revisions (PDF) Nov. 1, 2021, revisions (PDF)

July 25th, 2023 Thought I would share this information from a recent Linkedin post I received. "Centers for Medicare & Medicaid Services (CMS) offers this resource for state Medicaid and partner agencies seeking to address the needs of adults with intellectual and developmental disabilities (I/DD) and their aging caregivers with the aim of improving access to high-quality home and community-based services (HCBS) for people eligible for Medicaid. This resource synthesizes information on...

June 19th, 2023 HCS & CFC Certification Standards Adopted  As of June 21st, 2023 the new HCS & CFC Standards will be effective. These rules were transferred from Chapter 9 to Chapter 565, including both newly added rules (Ch. 263) and rules from Chapter 9  which have been revised to ensure clarity.  HHSC intends to post an Information Letter regarding the rules which will review each section of the rules in the document we have included below, as well as, those rules which have been...

June 15th, 2023  Legislative Bills:  The following 3 bills passed by the 88th Legislature were discussed: ~   HB 4169 (Price) relating to prevocational services:  The bill directs HHSC to either add pre-vocational services as part of ISS or to create a stand alone pre-vocational service. Access to HB 4169:  https://capitol.texas.gov/tlodocs/88R/billtext/pdf/HB04169F.pdf#navpanes=0 ~  HB 54 (Thompson) relating to increasing the personal needs allowance of persons in a nursing home or ICF/IID...

June 15th, 2023 New Portal Enhancement Training Information: More Info and Registration From the TMHP website: "Registration is now available for two training webinars to discuss the Long-Term Care (LTC) Online Portal enhancements for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs. The webinars are offered by the Texas Medicaid & Healthcare Partnership (TMHP). A TMHP training services representative will conduct the webinars, which will include...

June 14th, 2023 New! HCS Certification Rule:  HHSC announced that the rules being transferred from Chapter 9 to Chapter 565 will be published in the June 21, 2023 Texas Register  The announcement will be accompanied by an Information Letter. According to HHSC, the letter will explain rules and specify which rules are new, which have been revised to ensure clarity and which have been removed. **In addition, HHSC will conduct several webinars to review the rules with providers. Providers can...

June 10th, 2023 HHS, in collaboration with The University of Texas Steve Hicks School of Social Work, will host an informative two-day, free conference on quality in long-term care. Aug. 22-23 This year’s theme is, “Making a Commitment to Person-Centered Long-Term Care.” The conference offers presentations from nationally and internationally recognized experts. Topics include: Caring for people with dementia. Infection prevention and control. Long COVID considerations in long-term care Current...

May 13th, 2023 "The labor shortage has made it more important than ever to manage available resources effectively. Allowing existing employees to view and request open shifts can be a big help to over-stressed managers." Our friends at MITC have asked us to share some information on one of their very important resources, scheduling software for your shift staff in group homes and employees in general.  Please check all their info below and feel free to go to their website for more info on...

June 5th, 2023 Form 2125 from HHSC used int the HCS and TxHmL programs as the Implementation Plan form, was updated in Oct. 2022.  The form currently has a box to check this document if consent was obtained from the individual or LAR concerning receiving services via Synchronous Audio Visual Technology . Per standards of care, any professional therapy service or nursing service delivered using synchronous audio-visual technology must be clinically appropriate, safe, and agreed to by the...

June 5th, 2023 Just A Reminder About Consent For Synchronous Audio-Visual Technology Revision 22-3; Effective Oct. 19, 2022 As appropriate for the individual and as permitted by service-specific requirements, the modalities for delivering services to an individual includes: In-person Synchronous audio-visual Audio only In addition to meeting service requirements, providers must defer to the needs of the individual receiving services, ensuring the mode of service delivery is accessible,...

June 5th, 2023 HHSC's Response to Three Recent ISS-Related Questions From Providers   Question 1: May an Individualized Skills and Socialization (ISS) provider charge families for after-hour care?  Many times families cannot get off work at the time the program closes/services stop.  Some providers will keep their doors open until 5 or 6 (with staff present of course), until families get off work.  In these cases, the ISS providers charge families for that service. HHSC’s Response: If the...

May 28th, 2023 When to Call the IDD Ombudsman The IDD Ombudsman receives complaints from individuals, family members, and the general public about the care, treatment, or services provided to an individual. Individuals receiving services or family members of the individual may prefer to call the IDD Ombudsman to assist in resolving an issue rather than speaking with their LIDDA service coordinator (SC) or HCS provider. (In addition, if you are not sure where to make a complaint or who to make...

May 27th, 2023  Attestation and Initial & Final Reports  HHSC's Home and Community-Based Services (HCBS) Provider Retention Payments are part of the HHSC ARPA (American Rescue Plan Act) Spending Plan. These "Retention Payments" were meant to be a temporary rate add-on on eligible service claims with dates of service from March 1, 2022 to August 31, 2022, to agency providers and consumer-directed services (CDS) employers. HHSC adopted 1 Texas Administrative Code Section 355.207 governing...

May 10th, 2023 The PHE is Over, Now What?  What You Need to Know to Comply with Wage and Hour Laws Now that the Public Health Emergency Has Ended   Check out this webinar from ANCOR. This webinar does have a registration fee.  It is open to members and non-members of ANCOR! Wednesday, May 24, 1-2 pm EDT "The Impact of the PHE Unwinding On Wage and Hour Compliance" Register Today Now that the public health emergency (PHE) has ended, providers are navigating how to unwind from emergency...

May 15th, 2023 From HHSC Resources on Aging Know Your Neighbor Food Security Nutrition at Any Age Understanding Nutrition Social Determinants of Health in Aging Aging: By the Numbers Why Age Well Live Well

May 15th, 2023 New Tool To Help Providers & Direct Support Staff/Community Attendants With Employment! HHSC is launching Direct Care Careers Connect to help community attendants and employers connect beginning June 1, 2023. The online platform will allow community attendants to list work history, skills, certifications, trainings, and other job qualifications. Employers will be able to post job descriptions, job specifications, and other information to help find quality candidates....

May 15th, 2023 Recording Available of Webinar For LTC Provider Webinar on the End of Continuous Medicaid Coverage! HHSC hosted additional live webinars in March and April of 2023, to inform providers about the end of continuous Medicaid coverage. The webinar provided information about how long-term care providers (including nursing facilities, assisted living facilities, home and community support services agencies, Medicaid waiver providers, and intermediate care facilities for individuals...

May 14th, 2023  Guidance Related to Cooperation with HHSC Provider Investigations (PL 2023-11) HHSC has published PL 2023-11 Cooperation with HHSC Provider Investigations (PDF). The letter reminds providers that they must cooperate with Health and Human Services Commission Provider Investigators who are conducting investigations of abuse, neglect, and exploitation.

May 14th, 2023 Reminder Last updated on 12/7/2022 Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs) and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) have been submitting forms and claims to the Texas Medicaid & Healthcare Partnership (TMHP). In response to questions and concerns related to the processing of...

May 14th, 2023 On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System (CARE) and TMHP and will recoup services that exceed the authorized IPC amount. (From May 1st, 2023 forward) View the full alert here.

May 13th, 2023 Community Attendants & Direct Care/Support Workers: Direct care/support workers & community attendants are a huge part of the Medicaid long-term services and supports system. Without these persons working with our individuals, HCS, TxHmL, CLASS, ICF and other programs would not be able to provide services. The long-term services and supports system in Texas would simply not exist without a workforce of direct care/support workers. The Texas House and Senate have passed...

May 13th, 2023 May 2023 MCS COVID-19 Stakeholder Information Session Thank you for your interest in listening to the May 2023 Texas Medicaid CHIP COVID-19 Information Session. The audio from this session can be found here. Email us for transcript The presentation can be found here. This is the last scheduled stakeholder recording for COVID-19 updates. For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us. January 12th, 2023  January 12 Texas Medicaid CHIP COVID-19...

May 12th, 2023 Important Reminder:  Denial of Medicaid Eligibility HHSC has published IL2023-16 Termination of Waiver Services Due to Denial of Medicaid Eligibility. On Dec. 29, 2022, Congress passed the 2023 Consolidated Appropriations Act, which separated continuous Medicaid coverage requirement from the Public Health Emergency declaration. The requirement for states to maintain continuous Medicaid coverage ended as of March 31, 2023. States may begin disenrolling members effective Apr. 1,...

May 2nd, 2023 Infection Control Resources from HHSC Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF) Infection Control Basics & PPE Training for Essential Caregivers (PDF) Helping Individuals with Intellectual Disabilities and Related Conditions Prevent the Spread of COVID-19 (PDF) Long-term Care COVID-19 Vaccination Options (PDF) Resources Created by HHSC Evidence-Based Best Practices: Infection Control is a guide for developing a facility-wide...

April 27th, 2023 HHSC Long-term Care Regulation will be providing recurring one-hour webinars for Individualized Skills and Socialization providers. These webinars will cover the basics of a license application, and an overview of the survey process. Additional topics will include reporting abuse, neglect, exploitation or incidents to HHSC. All sessions are duplicates and offer multiple opportunities to facilitate provider attendance. Friday, April 28 3–4 p.m. Click here to register. Monday,...

April 14th, 2023 April 12, 2023 town hall meeting April topics included: Using the Provider Location Update (PLU) Form for moves/updates Entering Individualized Skills and Socialization in TMHP Highlighting Individualized Skills and Socialization Available Resources Questions and Answers – HCS/TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding the LTC Online Portal for HCS and TxHmL. You can register for the recorded session at:...

April 11th, 2023 **Please also check the HCS/TxHmL joint training website from HHSC, for periodic related webinars.  Training Resources (Videos, FAQ's, Quick Check Guides, CBT training) It is highly recommended that program providers, LIDDAs, and FMSAs create a TMHP Learning Management System (LMS) account at learn.tmhp.com to access current training related to the LTC Online Portal and claims submissions. New TMHP LMS users can access the Learning Management System (LMS) Registration and...

April 1th, 2023 Link to HCS/TxHmL TMHP Youtube Video Playlist

April 4th, 2023   New HCBS Rules (HCS and TxHmL) These new HCS rules have been added as TAC Title 26, Part 1, Chapter 263. Texas Home Living HCBS regulations for compliance requirements is the following TAC title 26 part I Chapter 262  

March 30th, 2023 I wanted to share the website for one of the ISS providers in the San Antonio area as they do also offer competitive employment for individuals and have employment assistance (EA) and supported employment (SE). Hope this is a good resource from some HCS/TxHmL providers in their area. https://www.texasfoundationofhope.org/    2845 Thousand Oaks Dr. San Antonio, TX 78232 (210) 265-3351 txfoundationofhope@gmail.com Office Hours: Monday – Friday  9:00 AM to 5:00...

March 30th, 2023 Review of this important section in 9.174 Service Delivery 9.174  (23)  (concerning HH/CC, RSS, SL on-site expectations including locks on bedrooms and hot water temps in the home) (23) ensure that, for an individual receiving host home/companion care, residential support, or supervised living:   (A) the individual lives in a home that is a typical residence within the community;   (B) the residence, neighborhood, and community meet the needs and choices of the...

March 30th, 2023 Service Delivery Logs for Individualized Skills and Socialization As of March 14th, 2023, information from the HHSC ISS SDL website page: ISS SDL Logs Form 8615, On-site and Off-site Individualized Skills and Socialization Service Delivery Log, and Form 8616, In-Home Individualized Skills and Socialization Service Delivery Log, are no longer mandatory to document a service claim of on-site, off-site, or in-home individualized skills and socialization. A program provider may...

March 30th, 2023 Update HHSC's Response to Some Of The Questions Concerning Cost Reports for 2022:  The HCS/TxHmL Units of Service Look-up tool was created at the providers’ request to assist them in completing the 2022 cost report.  Providers have questioned whether it captures all that is needed for the cost report and if HHSC is responsible for ensuring there is an appropriate report page for providers to collect this information in TMHP and/or Texas Med Connect. HHSC has stated that...

March 29th, 2023  Heightened Scrutiny Process For ISS (Individualized Skills and Socialization) Individualized skills and socialization has replaced day habilitation in these programs: HCS, TxHmL & DBMD. Individualized skills and socialization will include an on-site component and an off-site component. The heightened scrutiny process will be required if a setting in which on-site individualized skills and socialization is provided: (1) is located in a building in which a state supported...

March 26th, 2023 HHSC published PL 2023-06 Compliance with New HCBS Settings Rules HHSC Long-term Care Regulation published Provider Letter 2023-06 regarding Compliance with New HCBS Settings Rules on March 24, 2023. This letter explains how LTCR surveyors will assess HCS providers for compliance with the new HCBS settings requirements. March 15th, 2023 The Center for Medicaid and CHIP Services (CMCS) is sharing this toolkit with State Medicaid Agencies, Operating Agencies, and other...

March 20th, 2023 ​88th Legislative Session in Texas! Here Are A Few House Bills Submitted That May Affect Long-Term Care & Other Services For Persons With Disabilities HB 54: Personal needs allowance for certain Medicaid recipients who are residents of long-term care facilities. HB 144: Possible Exemption from ad valorem taxation of the total appraised value of the residence homestead of an unpaid caregiver of an individual. HB 166: The appointment of an educational representative for...

March 19th, 2023 Individualized Skills and Socialization Joint Training Opportunities For:  Applicants For ISS Licensure and New ISS Providers HHSC Joint Provider Trainings will host a 1-day live training (Austin, Tx) that will cover the licensing process for the Individualized Skills and Socialization Program, as well as an overview of the rules, survey process, and reporting requirements for allegations of abuse, neglect, and exploitation. Introduction to Individualized Skills and...

March 5th, 2023 Thanks to our friends at ARC for posting this in one of their recent newsletters 1915(c) Waiver Interest Lists by Legislative District Find below maps produced by The Arc of Texas showing how many Texans on Medicaid waiver interest lists live within each State House, State Senate, and Congressional district. The Medicaid waivers being tracked are all CLASS, DBMD, HVC, MDCP, STAR+ PLUS, and TXHML. The darker the hue of the district, the more people there are on any interest list...

February 27th, 2023 Letter IL 2023-09 discusses that Sections 263.502 and 263.503 (a)(1)(A) and (b) through (m) of the new Chapter 263 CMS rules do not apply to HH/CC providers in which the HH/CC provider is an immediate family member of the person receiving HH services.  See page 1, 2nd paragraph of the IL for the definition of an immediate family member.  Sections 263.502 and 23.503 (a)(1)(A) and (b) through (m) will however, apply if a HH/CC provider does not meet the definition of an...

February 25th, 2023 Please click on links below to find the referenced rules which were published as adopted on February 24th, 2023, with an effective date of March 1, 2023. HCS Rules TxHmL Rules Please be aware of the following: Only the rule provisions to which changes were made are included in the links above.  I believe HHSC will post the complete set soon. You are urged to read the preamble to the rules, in particular HHSC's responses to comments received from stakeholders, before reading...

February 22nd, 2023 I know providers have really been concerned about the period of time between March 1st and May 11th while the PHE has been extended, as to whether or not this will include ISS services for In-Home ISS. HHSC stated it would release a notice soon stating that beginning March 1, 2023 in-home ISS can be done without the justification (medical or behavioral justification or anyone 55 years of age and older should they request such) for such that will be required in the rules,...

February 22nd, 2023  In-Home ISS in HH/CC Settings:  If persons receiving HH/CC services receive in-home ISS only, the provider does not have to be licensed.  If the person receiving HH/CC services engages in community activities (known as off-site ISS), then the provider of the off-site ISS must be a licensed ISS provider.  Note:  EVV is NOT required for in-home DH or in-home ISS in a HH Setting - EVV is only required in own home/family home settings.  Also, the requirement for EVV matching...

February 21st, 2023 Update on Who Qualifies To Assess The Need For A Modification According to HHSC (and the proposed rules that will now be under Chapter 263) modifications to the door lock requirement must be based on a documented, assessed need and brought to the SPT for review and documentation in one's PDP As to whom determines the assessed need, HHSC stated at recent training sessions in Lake Jackson and Austin I believe, that a licensed professional, defining such as a doctor, RN,...

February 14th, 2023   Repeal of HCS Rules under Title 40, Chapter 9 / Movement to Title 26, Chapter 565 Attached please find the proposed changes to the HCS certification principles. The proposed changes repeal rules under Chapter 9, Subchapter D and move to Chapter 565.  Remember that in addition to moving the rules to Chapter 565, several new rules are mentioned to be put in place as well as changes to existing rules for purposes of either updating, streamlining or providing clarity in...

February 10th, 2023 From HHSC's PAT  FAQ's as of Jan. 1st, 2023 "Frequently Asked Questions for Providers Applicant Training (PAT) for HCS/TXHML" -When is the Provider Applicant Training (PAT) Online available? This training is now available online. The PAT training is the first step for applicants to obtain a contract with HHSC. Please do not submit your application without the PAT certificate that reflects a passing score of 85% or above. -Who can take the training? Applicants listed on Form...

March 2nd, 2023 Unwinding of Continuous Medicaid Coverage:  HHSC will stagger Medicaid Eligibility Determinations, separating into 3 groups.  IDD will be in the last group, meaning that packets will be sent in June with persons having 30 days to reply.  More information can be found at:  https://www.hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-provider-information/end-continuous-medicaid-coverage-ambassador-toolkit February 9th, 2023 The Biden administration plans to...

February 9th, 2023 Where can you find helpful Training Videos on the PEMS process? Check out the TMHP page with their Youtube videos for PEMS. In addition, you will find information on removing TPI's and a Video series on running and utilizing your R&S Reports 1915 (c) waiver page at TMHP For YouTube Training Videos Specific link to R&S Report Video Series Specific link to Removal of TPI From Forms Video

February 5th, 2023 Proposed HCS and TxHmL Billing Requirements Home and Community-based Services and Texas Home Living stakeholders can now comment on the proposed revisions to the HCS and TxHmL Billing Requirements by Feb. 14. The proposed billing requirement revisions and a summary of changes are located on the Long-term Care Providers webpage and are outlined below: HCS HCS Billing Requirements Draft Revision 23-2 (MS Word) HCS Billing Requirements Draft Revision 23-2 Summary of Changes...

January 5th, 2023 IMT and IPC Form Enhancements and IBI Guide Updates Now Available Last updated on 1/27/2023 From HHSC: "On January 13, 2023, a text box replaced the location code drop-down box on the following Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Individual Movement (IMT) and Individual Plan of Care (IPC) form fields: IPC transfers (3608/8582) field 39a: Receiving Program Provider Location Code IMT (all-purpose codes) field 18: Location Code IMT Individual...

January 31st, 2023   Advocacy Toolkit from our friends at the ARC of Texas https://www.thearcoftexas.org/wp-content/uploads/Advocacy-Toolkit.pdf

Please go to www.twogetherconsulting.com for more information and registration. Click on  "the calendar" of the Webinar you want to attend.  ********We also have pre-recorded webinars you can purchase for use at your facility.  Please contact Meghan Jones at: meghanjones.tx@gmail.com for more information, registration, and payment.     February 2023   Common Nursing Violations:  Prevention & Correction  February 23rd, 2023 10 AM-12:00 PM (ICF/IID)     The HCS/TxHmL...

January 27th, 2023 As of 1/27/23, there have been no new alert letters concerning the extension of temporarily waiving certain requirements for In-Home DH  due to the Public Health Emergency, past  January 31st, 2023. This was the date we were given in Letter No. 2022-55. My understanding is providers would receive notice at least 30 days prior to ending the PHE.  I am assuming at this time that the PHE will extend through Feb. 28th, 2023.  In-Home DH billing will discontinue in TMHP as of...

January 27th, 2023 HHSC Form Required for Fire Drills for ISS Providers Click on link below Form 4719 * Some providers have noted that this form seems a bit inappropriate for ISS providers as the form has locations that seem more appropriate for a "home" setting, as opposed to maybe a "building" used by a licensed ISS provider, but it does have a box for "other" locations.

January 16th, 2023 Statewide Transition Plan CMS requires states to submit a transition plan describing the state’s planned initiatives and activities for achieving compliance with the federal HCBS Settings Rule. HHSC has received initial approval of its transition plan and has updated the plan to include additional information required for CMS to grant final approval. This version of the STP includes new information about site-specific assessments, ongoing monitoring and oversight,...

January 16th, 2023 Adoption Date of HCS Rules and Status of Statewide Transition Plan (STP):  gave HHSC preliminary approval of its STP on 12/21/2022.  The STP will be posted for public comment this Friday (Jan. 20th, 2023). It is unclear when the HCS rules will be adopted. See graph of draft rules below (pages 12-17 for HCS).  Includes CLASS, TxHML, MDCP, and DMDB programs as well. Appendix A: Home and Community-Based Services (HCBS) Settings Statewide Transition Plan  ...

January 15th, 2023 TMHP Recoupment Letters Recoupment Letters:   Upon request, TMHP will send a list of affected/over-paid claims to providers. Providers who experience any issues receiving the list should contact Marie Redman at HHSC (marie.redman@hhs.texas.gov). HHSC urges providers to keep their ticket numbers.  Why? Because the calls are recorded, and if there's an issue, the ticket number allows HHSC to listen to the call associated with the ticket number.  This is just one of the...

January 15th, 2023 Help With The New Residential Agreements Concerning the on-site assessments, HHSC plans to help providers with the soon-to-be required residential agreements. According to HHSC, the assistance is to ensure providers' agreements meet the minimum requirements of the rule.  There was no elaboration of the type help to be offered other than HHSC will reach out to each provider. HHSC further stated that an Information Letter would soon be posted directing providers to initiate...

January 14th, 2023 Have You Signed Up For CIMS (Critical Incident Management System)Yet?  There are still quite a few providers who have not done so.  HCS & TxHmL providers please do so right away. TMHP has stated that FEI Systems sent emails to required users who had yet to log into CIMS.  Some providers have indicated that they did not receive an email.  According to HHSC FEI Systems did send emails out using a DONOTREPLY/FEI email address.  If you did not receive this email, please...

January 12th, 2022 From our good friends at the Texas Chapter of AAIDD, some important info about the Texas 88th Legislative Session See actual TAAIDD link   Dion White, Center for Life Resources AAIDD Texas Chapter Board Member "Texas is home to more than 500,000 adults and children with intellectual and developmental disabilities (IDD). This legislative session will be very important to address specific changes happening within the IDD systems of care across the State. ​ Our system of care...

Employment Assistance & Supported Employment Training Options From HHSC   January 12th, 2022 Please see notice below from Monty Chamberlain, HHSC. "HHSC is pleased to announce the delivery of in-person Employment First / Employment Services training for the first time since 2019.  This free one-day training opportunity has proven to be a very valuable opportunity to various levels of staff involved in the support of individuals who set the goal of competitive and integrated employment...

January 11th, 2023   RENEWAL OF DETERMINATION THAT A PUBLIC HEALTH EMERGENCY EXISTS   "As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19)  pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective January 11, 2023, the January 31, 2020,...

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),...

January 10th, 2023 Below are just some of the trainings offered by HHSC on their "Trainings Initiative" page. Some live and some via webinar. For more information, please go to: https://www.hhs.texas.gov/providers/provider-training/training-initiatives SSI/SSDI Benefits Overview The SSI/SSDI Benefits Overview web-based training provides a basic foundation for understanding Supplemental Security Income and Supplemental Security Disability Insurance and provides contact information for people...

Free Webinars!! Our free webinar session recordings previously recorded are currently posted on our "Gotostage" page. https://www.gotostage.com/channel/3b0bd3b1a47c4e80be974f4bcfa54d7b January 2023 Webinars   Core-VA Solutions "Virtual Healthcare Assistants For LTC Programs" Virtual Healthcare Assistants Services and Training for Long-Term Care Programs, including HCS, TxHmL, and ICF Free Webinar Series Hosted By: Twogether Consulting (1/10/22 from noon-1pm)   Pre-Registration is...

January 2nd, 2023 Effective January 2023, the open enrollment application process to get a provisional contract to provide Home and Community-based Services (HCS) and Texas Home Living (TxHmL) services will change. You must be enrolled as a Texas Medicaid provider through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment System (PEMS) before applying. 2. To apply, you must complete the Provider Applicant Training (PAT). The PAT is now available on the HHS Learning...

January 2nd, 2023 HHSC published an alert on Dec. 21, 2022, informing long-term care providers that expedited delivery is available for a limited time for personal protective equipment through the Texas Division of Emergency Management. This resource is available to all long-term care providers, including: Nursing Facilities Assisted Living Facilities Intermediate Care Facilities Home and Community-based Services Home and Community Support Services Agencies, including Community Living...

January 1st, 2023 LTC Winter and Extreme Freezing Weather Preparedness HHSC encourages long-term care facilities and agencies to review and update emergency plans for freezing temperatures and snow. Emergency plans for extreme weather should include the provider’s plan to address: Power loss Water and food needs Communication to families and staff Staffing shortages Sheltering in place and evacuation as applicable Providers must follow emergency preparedness rules and their own internal...