Twogether Updates
STATEWIDE TRANSITION PLAN: HCBS
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, non-disability specific setting options, communications with beneficiaries regarding provider choice, and notification of provider non-compliance.
HHSC will submit a final Statewide Transition Plan (STP) to the Centers for Medicare and Medicaid Services (CMS). The STP is posted for public comment. All states must obtain final approval of their STP from CMS to comply with the federal Home and Community-Based Services Settings (HCBS) Rule. The STP describes HHSC’s activities and planned initiatives for meeting the requirements of the HCBS Settings Rule.
HHSC invites members of the public, including HCBS recipients and their families, providers and other stakeholders, to submit comments on the STP. Comments will be accepted until 11:59 pm on Feb. 13, 2023.
Access the STP and instructions for submitting public comments here.
Written comments, requests to review comments or both may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or email.
Email: Medicaid_HCBS@hhs.texas.gov
Fax:
Attention: Rachel Neely, Office of Policy at 512-438-5835
U.S. Mail:
Texas Health and Human Services Commission
Attention: Rachel Neely, Office of Policy
John H. Winters Complex
701 W 51st Street
Mail Code H-600
Austin, TX 78751
Overnight mail, special delivery mail, or hand delivery:
Texas Health and Human Services Commission
Attention: Rachel Neely, Office of Policy
John H. Winters Complex
701 W 51st Street
Mail Code H-600
Austin, TX 78751
Phone number for package delivery: 512-438-4297
TMHP Portal Town Hall Meeting on 1/11/23: Helpful Information From This Session
January 16th, 2023
Helpful Information: From TMHP Portal Town Hall Meeting on 1/11/23
-A representative from one of the LIDDAs (Alamo Area Council of Governments) relayed the following information:
- If an individual moves from one LIDDA to another (LIDDA to LIDDA transfer) and they are going to new HCS or TxHmL provider, the old LIDDA has to do INT form 1st and then the new LIDDA has to do the transfer to the new provider. These things must happen in this order, or it will hold things up in your transfer.
- One of the major problems the LIDDA’s have is that the LOCATION code is being changed by the system (a glitch of some sort in TMHP) and then it is greyed out by the system so they can’t put anything in that spot where location code goes. They can’t edit it to correct it. This has caused many of the delays in transfers and this is why alot of providers might be thinking the LIDDA is causing the delay. However, that may not be the case because of this issue. Good news: Enhancement to allow the LIDDA to type in location code instead of grey out barrier. This is happening Friday Jan. the 13th. This should provide a resolution to this “glitch” in the system. Hopefully, it will allow a lot of transfers to go through. This problem has been happening since April of 2022 for LIDDA’s.
- FYI-HHSC sent out a letter to LiDDAS, that they should not hold up on transfers if the location code is not correct. They can then contact HHSC about correcting the location code after the fact.
-In some situations, if the LIDDA itself is not changing during the transfer (transfer from one provider to another, but LIDDA the same), then the provider needs to make the changes on the IMT form before the -LIDDA can submit. They have to complete the process in that order before the transfer can be submitted. Meaning the previous form must be done before the new form should be completed.
-One of the HCS providers shared the following information: Somewhat related to location codes. She was closing a couple of location codes after the home was no longer open. Noticing that the drop-down list is out of sync. She would put in the address of the new location and go to close the old location code and the drop-down link showed a different address for the location being closed out than it should. It is like it is out of sync. This fix happening this Friday should also fix that for the provider. Basically using right code but the wrong address is showing up in the dropdown menu’s. Referring to PLU system.
-If providers are experiencing any delays with LIDDA not submitting any forms they are required to submitted. Please try to resolve that by escalating that to LIDDA director, so HHSC says they want you to then send an email to interestlistpreenroll_liddahelp@hhs.texas.gov. then they can reach out to them directly.
–To escalate tickets: Email. LTCOPS-Escalations@TMHP.com to escalate tickets
-Another provider noted the following issue: When they migrated to TMHP, somehow their contract address was now incorrect. The provider’s company name was no longer associated with the right contract #. It is not something the provider did on their side. So far, they have had no luck in changing that address to the correct address for their contract #. Provider information update. They will need to check it on the provider system data to find out. Contract and Administration and Monitoring will have to help with the correction of the error. This is also the case if providers have questions about a contract’s begin and end date, or when it expires, etc.. Go to the contract manager. HHSC acknowledges that there has been alot of turnover in this department. (Don’t I know it, lol.) Information provided by Kaliope Schmidt was to do the following: Go to iddwaivercontractenrollment@hhsc.state.tx.us and cc Kaliopi.schmidt@hhs.texas.gov
–One Provider had a Transfer since May of 2022 that hasn’t gone through because the old provider’s address is showing on the location since transferring, so it does not match the contract of the new provider. Hopefully, the fix will come from the Friday the 13th, 2023 enhancement.
–Client assignment question: In the CARE system, this was done differently than in THMP so has caused a domino effect. i.e. Individual on temp discharge, would be re-assign to a different temp discharge location code. The local authority wanted her back into rotation. ……. We can’t view who is assigned to what location on what date, so couldn’t figure out how to move people sometimes. People at the help desk don’t even know how to look up people’s locations and assignments. What can we do?
To do that in the portal for now until June 2023, when they will have an enhancement out to correct this issue, providers must use the form status inquiry page (FSI) you can search for the consumer’s forms by imputing their Identifier (Medicaid or CARE #) and put in with search criteria. Leave the form blank but put in the date range or a little bit longer time if needed and search that. In the list should receive list of forms for the consumer for your organization. The effective date on the forms, if you click it, the system will show the list by effective date and which code has the latest effective date, and then that form as the latest location code. But won’t help unless the form is completed already. Location availability information is limited. The provider has to keep trying to look up everything in a fashion that seems long and very backward. It is the opposite of what the provider needs. It ends up being the longest way to look if up. The provider asked if they would create something in their June enhancement, that shows the moves of a person, hoping to build the function to search the function by location, what client is with them.
-If on temp discharge is the individual still assigned a code from the facility or a new code form (IMT suspension purpose code form)? Because the provider currently has to wait for the suspension form to finish the process so it is considered complete before they can do anything. How long does that usually take? Ask CARE people to get back to you.
-Another provider said they can’t do IMF form til the Residential component is changed but can’t change the residential component until IMF changed. Moving from 1 location to the other inside the same agency. Moving from HH/CC to RSS. So, when they try to change the residential type, it won’t let her progress from there in TMHP. Provider needs to submit IPC revision to change residential type. Then at the same time on that revision form, then the location code is updated for you to update IMF automatically. Don’t need to do the IMT, just the IPC revision form to change the residential type and location code. That changes the residential component type, submit IPC revision or transfer if that is the case.
-How do you know what claims to pay when you get your overpayment letter? To request a list, please contact the THMP-LTC Help desk at 1-800-626-4177 or 1-800-626-5436 (Option #1 then Option #7). The provider will need to provide a secure email for them to send the list. Should get within 24 hrs. Can also go to your Tex Med connect and remittance status screens.
HHSC asked providers to limit ISS questions at this time, but here is one that came up during the session:
-In-Home ISS come March 1st, 2023-does the provider need to submit documentation like BCBA documentation or medical/physician’s order of need, before it is entered into TMHP billing? Anything the provider needs to be prepared for? They have to go back and find out about it. Don’t know now.
Other Important Contacts:
Issues that go to UR (Utilization Review): • 8578 ID/RC form with purpose code 3 or 4 on the LTC Online Portal • Renewal or revision IPCs
Utilization Review (UR)
512-438-5055 email: deskURLONIPC@hhs.texas.gov
Issues that go to PES (Program Enrollment Services) • 8578 ID/RC with a purpose code 2 forms * initial or transfer IPCs forms • Suspensions • 3615 Continuation of Suspension forms • 3616 Request for Termination forms • Individual Movement (IMT) forms for LA Reassignments
Program Eligibility and Support (PES)
512-438-2484
enrollmenttransferdischargeinfo@hhs.texas.gov
When Will HCS New Rules and Status of Statewide Transition Plan (STP) Be Adopted?
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
ISS Updates & New Rules (HCS/TxHmL)
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:
HCS/TxHML: /TMHP Recoupment, Due To Overpayment
January 15th, 2023
TMHP Recoupment Letters
December 12th, 2022
Avoiding HCS and TxHmL Overpayment of Services
Effective Jan. 2, 2023, Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.
On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount.
On-Site Assessments of HCS Group Homes & Certain HH Settings From CMS
Help With The New Residential Agreements
-An individual’s bedroom door is lockable by the individual, with only appropriate staff having keys to doors.
– An individual has access to food at any time.
TMHP: HCS and TxHmL Waiver Programs: Trending Issue Support
January 14th, 2023
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 15
- Trending Support Issues, Vol 15: If you missed it, know that it includes information about determining your ARPA payments: https://www.tmhp.com/news/2022-12-30-hcs-and-txhml-waiver-programs-trending-issue-support-volume-15
December 16th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 13
Since May 2, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies billing on behalf of Consumer-Directed services have been submitting claims and forms to the Texas Medicaid and Healthcare Partnership (TMHP).
TMHP has received feedback from providers and LIDDAs indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert.
November 20th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 12
Since May 2, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies, billing on behalf of Consumer-Directed Services, have been submitting claims and forms to the Texas Medicaid and Healthcare Partnership (TMHP).
TMHP has received feedback from providers indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert.
October 17th, 2022
HCS and TxHmL Waiver Programs: Migration Trending Issue Support, Volume 10
October 7th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 9
Since May 2, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies, billing on behalf of Consumer-Directed Services, have been submitting claims and forms to the Texas Medicaid and Healthcare Partnership.
TMHP has received feedback from providers indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert
-Preventing claim denials for invalid date spans
Claims billed with date spans may deny with one of the following explanations of benefits (EOBs):
F0126: Claim line items cannot span current fiscal years.
The new state fiscal year (SFY) runs from September 1, 2022, through August 31, 2023. Claims will be denied with EOB F0126 if they are submitted with line item dates of service (DOS) spanning the previous SFY ending August 31, 2022, and the current SFY. Providers and LIDDAs submitting claims with DOS spanning the previous and current SFYs should submit separate claims for each SFY.
F0326: Incorrect number of days billed for this service.
Services that only allow billing for individual DOS may be denied with EOB F0326 if they are billed with date spans. These services should be billed as separate line items for each service date.
-Claims adjustments reminder
Claims that have processed successfully can be adjusted. For instructions on how to adjust claims, refer to the “Adjustment” section of the LTC User Guide for TexMedConnect.
Providers can also adjust a previously adjusted claim in TexMedConnect. For instructions, refer to HCS and TxHmL Waiver Programs: How to Adjust a Previously Adjusted Claim
September 11th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 8
-Termination Forms Submitted by LIDDAs
For clients who have CDS services only, termination forms are submitted by LIDDAs. After form submission, LIDDAs need to contact HHSC Program & Eligibility Support (PES) to acknowledge and review the forms. LIDDAs can contact HHCS PES by calling 512-438-2484, faxing 512-438-4249, or emailing enrollmenttransferdischargeinfo@hhs.texas.gov.
Read more on the following items:
–Long-Term Care Online Portal Sessions Must Be Restarted Daily
–Using the “Resubmit to SAS” Button
Access to Electronic R&S and PDF R&S Reports
August 31st, 2022
Migration Trending Issue Support Vol 7:
August 16th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support Volume 6
–Individual’s residential address in Individual Search
–“Pending LA Review” status and action needed
–Using the correct IMT Form to update the service coordinator (SC)
–HCS and TxHmL call queue
For info on these trending issues see the following link:
https://www.tmhp.com/news/2022-08-16-hcs-and-txhml-waiver-programs-trending-issue-support-volume-6
August 13th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support Volume 5
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) that bill on behalf of consumer-directed services (CDS) have been submitting claims and forms to Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers indicating that additional support is required.
Here are the latest resolutions to trending issues below:
HCS and TxHmL Call Queue
Status: When contacting TMHP, providers need to select option 1 then option 7 to enter the HCS and TxHmL Waiver Programs queue. The full number is 800-626-4117, Option 1, then Option 7.
Location Code Issue
Resolution: LIDDAs submitting Individual Plan of Care (IPC) transfers for clients were receiving incorrect location codes. This issue has been resolved. Providers that received an incorrect location code need to resubmit the IPC transfer.
See previous Volumes and info below:
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 4
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 3
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 2
HCS and TxHmL Waiver Programs: Trending Issue Support
Important Claims Submission Information for HCS and TxHmL Programs
LTC Online Portal Dashboard Accessibility Issue Resolved
IPC Forms 3608 and 8582 Issue Resolved
HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022
Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs
Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP
EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission
June 1st, 2002
Resolutions to the most frequently reported issues may be found at the following link for TMHP issues concerning entering IPC’s, dual entry into CARE, submitting claims, and more: “Trending Issue Support” Table
In addition, please see helpful links below including recent HCS/TxHmL FAQ’s in May of 2022.
View previous postings:
- Important Claims Submission Information for HCS and TxHmL Programs
- LTC Online Portal Dashboard Accessibility Issue Resolved
- IPC Forms 3608 and 8582 Issue Resolved
- HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022
- Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs
- Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP
- EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission
Initial Critical Incident Management Services (CIMS) User Account Email
Have You Signed Up For CIMS (Critical Incident Management System)Yet?
Initial CIMS User Account Email
On Monday, Aug. 29, FEI Systems sent another mass email to Critical Incident Management System (CIMS) users who have not logged into CIMS. It will provide your user ID and temporary password. The temporary password in the email will expire after seven days.
This applies to:
- Community Living Assistance and Support Services providers and case management agencies
- Deaf Blind with Multiple Disabilities providers
- Home and Community-based Services providers
- Texas Home Living providers
- Local intellectual and developmental disability authorities
Please do not delay logging into your organization’s CIMS account. The account creation email will come from FEI Systems.
Providers are required to begin entering critical incidents into CIMS by Nov. 1. HHSC strongly encourages providers to become familiar with the system as soon as possible.
ISS (Individual Socialized Services) FAQ’s
January 13th, 2023
ISS FAQs: Updated January 13th, 2023
August 23rd, 2022
Frequently Asked Questions HHSC shared during the ISS draft rules webinar on August 23rd, 2022.
These are questions received during the ISS webinar on July 19th, 2022
Q1: Will current day hab providers be grandfathered into the new
program? Or do they have to be program provider to have a day hab
contract with HHSC?
A1: No, Day Hab Providers are not grandfathered into the Individualized Skills and
Socialization program. Any provider who is interested in delivering Individualized
Skills and Socialization services must obtain a Day Activity Health Services or DAHS
– Individualized Skills and Socialization service category license, even those who
are currently providing day habilitation services.
Q2: Are the off-site activities generated from the individual PDPs or does the
ISS facility plan the activities?
A2: Off-site activities are generated from the individual’s Individual Plan of Care
and Individual Program Plan in the DBMD waiver program. In TxHmL and HCS, an
Individualized Skills and Socialization provider must provide off-site Individualized
Skills and Socialization in accordance with an individual’s PDP, IPC, and
implementation plan.
Q3: If the in-home service provider does not need to be an ISS
provider, does that mean that they can be a parent?
A3: A person who meets the Service Provider Qualifications for In-Home
Individualized Skills and Socialization, including a parent of an adult child
can provide Individualized Skills and Socialization.
Q4: What is the enhanced staffing rate? How does that work?
A4: An enhanced staffing rate is available in the HCS and TxHmL Programs
for an individual who requires more service provider support than the
individual would receive with the individual’s assigned LON. The requirement
for additional support may be because of the individual’s mobility, medical,
or behavioral needs. The program provider may request the enhanced
staffing rate for an individual with an LON 1 or LON 5 in the HCS Program, or
any LON in the TxHmL Program.
Q5: If the PDP do not specify how often a client needs to go out, will that be up
to the discretion of the individualized skills organization to decide how often
they go out?
A5: It is the individual’s choice for how they choose to receive off-site Individualized
Skills and Socialization and off-site Individualized Skills and Socialization must align with
the individual’s PDP, IPC, IP, and in DBMD the individual’s IPP.
Q6: Do we need to provide meals and snacks? Have a paid nurse on site? Can it
be an LVN?
A6: An Individualized Skills and Socialization provider does not need to provide meals
and snacks to the individuals, but they must provide personal assistance for an
individual who cannot manage personal care needs including eating during an
Individualized Skills and Socialization activity. An Individualized Skills and Socialization
provider must also be able to provide assistance with medications and the performance
of tasks delegated by a registered nurse.
Q7: Is there going to be an open enrollment period for ISS with times of the year
that are closed, or is it an open enrollment?
A7• An individual in the HCS, TxHmL, and DBMD Program can add Individualized Skills
and Socialization to their IPC at any point during the plan year. It is the individual’s or
their LAR’s choice if they would like to receive individualized skills and socialization.
• Any provider who is interested in delivering Individualized Skills and Socialization
services must obtain a Day Activity Health Services or DAHS – Individualized Skills
and Socialization service category license. The provider may apply at any time once
the online licensure portal (TULIP) is operational. HHSC anticipates that the license
application process will be available late November or December.
Q8: Are staffing ratios minimum or maximum? Will providers be reimbursed if
they go over the ratio?
A8: The staffing ratios described in the rule indicate that they are “no higher than” i.e.,
they describe the maximum ratio of individuals to service providers of Individualized
Skills and Socialization. To receive reimbursement and avoid recoupment of funds,
Individualized Skills and Socialization services (on-site, off-site, or in-home) must be
provided in accordance with the HCS, TxHmL, or DBMD Program rules.
Q9: Will ISS providers be required to have RNs as part of staff now that
medication management is part of the program? Additionally, our day hab does
not currently enroll individuals that need help with toileting or feeding needs,
will the program require that we do enroll these LONs individuals?
A9: If an individual receiving Individualized Skills and Socialization needs assistance
with medication or other nursing tasks, the HCS program provider’s nurse must ensure
the Individualized Skills and Socialization service providers are delegated/trained to
deliver the service. Individualized Skills and Socialization providers like day habilitation
providers can refuse to accept a person for services.
Q10: Is there any guidance regarding scheduling? For example, is the service
only Monday-Friday, etc.
A10: There is not a requirement for how many hours per day an Individualized Skills
and Socialization provider needs to provide services. There is a service limit for the
combined total of on-site, off-site, and in-home Individualized Skills and Socialization for
HCS and TxHmL of 1560 hours during an IPC year, six hours per calendar day, and five
days per calendar week.
Q11: Does an HCS, TxHmL or DBMD provider have to apply to be licensed as ISS
provider?
A11: An active day habilitation site could choose not to participate in Individualized Skills and
Socialization and not apply for a license. They would no longer be able to provide day
habilitation to individuals in HCS, TxHmL, and DBMD after March 1, 2023, since day hab will
no longer be a service at that point. Any provider who wishes to deliver Individualized Skills
and Socialization services will be required to have a Day Activity and Health Services –
Individualized Skills and Socialization license. A provider must obtain a temporary license
prior to delivering Individualized Skills and Socialization services and may choose to do so at
any time once the licensing system is available. HHSC Long-term Care Regulatory will issue a
provider a final license after conducting an on-site visit that results in final approval of the
license.
Q12: In the examples of ratios given, there was not an example that included an ICF
client. What are the expectations when mixing ICF clients with waiver clients?
A12: If a person is not in the TxHmL, HCS, or DBMD Program and is receiving services by a
staff member who is also providing on-site Individualized Skills and Socialization to an
individual in the DBMD Program or off-site to an individual in the HCS, TxHmL, and DBMD
Program, the appropriate HCS, TxHmL, and DBMD staffing ratio must be applied, and that
individual must be included in the staffing ratio.
Q13: If someone’s PDP says they need XX hours in the community, but we do
not have the manpower, are we still able to work with the client?
A13: Waiver providers can engage the Individualized Skills and Socialization
providers in the development of the implementation plan by identifying free or low-
cost activities (affordable by the individual) the Individualized Skills and Socialization
providers can offer within their community and match well with the individual’s
interests. Off-site Individualized Skills and Socialization is provided in a community
setting chosen by the individual from among available community setting options.
Community settings are settings accessible to the general public within an
individual’s community.
Q14: Day hab allowed for 5-hour minimum days, so now under ISS is it going
to be required to be 6 direct services timer?
A14: The service limit for the combined total of on-site, off-site, and in-home
Individualized Skills and Socialization for HCS and TxHmL is:
(1) 1560 hours during an IPC year;
(2) six hours per calendar day; and
(3) five days per calendar week.
Individuals can receive less than six hours per calendar day.
Q15: If the individual/LAR choses not to utilize the ISS program, will
they still be able to receive funding from TxHmL/HCS?
A15: The individual or LAR can choose to receive in-home Individualized
Skills and Socialization if the individual meets the policy for in-home
delivery. Individuals living in three and four person residences would need
to participate in employment or day activity with natural supports if the
LAR or individual does not choose to receive individualized skills and
socialization and does not meet the policy guidance for in-home
individualized skills and socialization. Access to HCS and TxHmL waiver
services is not dependent upon receiving individualized skills and
socialization.
Q16: Can we have a combination of HCS waivers and private pay? Does private
pay also need to be in the community?
A16: Individualized Skills and Socialization providers will have a choice about how to
conduct business. They will be allowed to accept all payor sources, or they may choose
to accept only waiver (HCBS) or non-waiver. The HCBS settings regulations do not apply
to ICF/IID, private pay or general revenue and therefore, day habilitation can continue
to be provided without changing the service to individualized skills and socialization;
however, if a provider wants to serve individuals in the waiver programs, the provider
must do so as a licensed individualized skills and socialization provider after March 1,
2023. Individualized skills and socialization has both on-site and off-site services that
must be offered to individuals in the waivers.
Q17: Will ISS provided in the client’s home require EVV verification for HCS and
TxHmL funded clients? If the client lives in a group home or a Host
Home/Companion Care home, will the EVV verification be required?
A17: In-home Individualized Skills and Socialization provided in the individual’s own
home or family home will require the use of EVV verification, similar to in-home day
habilitation today. If the individual lives in a 3-person or 4-person residence, or a host
home/companion care residence, EVV verification will not be required.
Q18: Will we need a separate license for each day hab our individuals
attend including any families that provided in-home day hab due to
their LON and medical need?
A18: Each physical location that provides on and off-site Individualized Skills
and Socialization services will require its own license and application process.
In-home services will not require a license.
Q19: Can you give a few examples of offsite locations?
A19:Visits to the museums, libraries and parks are examples of off-site
Individualized Skills and Socialization activities if they are chosen by the
individual, integrate the individual into the community, and promote the
development of skills and behavior that support independence and personal
choice.
For further questions, contact:
HCSPolicy@hhs.texas.gov
TxHmLPolicy@hhs.texas.gov
LTCRPolicy@hhs.texas.gov
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
AAIDD Texas Chapter: Link To Follow Bills During The Texas 88th Legislative Session
January 12th, 2022
From our good friends at the Texas Chapter of AAIDD, some important info about the Texas 88th Legislative Session
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 specific to IDD is currently undergoing changes in its service delivery system. One aspect of this change deals with a transition of IDD long term services and supports going from a traditional Medicaid model to a managed care model. Currently there are plans to pilot test this transition starting in September 2023. This is major change because it may impact the monitoring role of targeted case management. Through targeted case management, services are monitored to insure continuity over time. Currently the IDD local authorities are providing the TCM service.
As Texas continues to grow there is a concern if the entire system of care across the State will grow to meet the increased need of services. Many providers are also dealing with staffing shortages across the State which is making the situation much more difficult. There is a possibility this will be addressed either directly or indirectly during this session.
During this session there will be a-lot of discussion on addressing the IDD population in regard to the new programs starting such as Individualized Skills and Socialization services. The session started on January 10 and will end on May 29th. I encourage all stakeholders to follow legislation specific to IDD services and supports and contact your designated legislator with any concerns you may have. “
A good resource to follow bills online can be found at this link, https://capitol.texas.gov.
Important- Recordings Available From HCS and ICF Webinar COVID-19 from HHSC
January 12 Texas Medicaid CHIP COVID-19 Information Session.
These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.
The audio from this session can be found here.
The presentation can be found here.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
December 1 Texas Medicaid CHIP COVID-19 Information Session.
These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.
The audio from this session can be found here.
The presentation can be found here.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
Medicaid and CHIP Services Has Updated Its Process of Sending Monthly COVID-19 Updates
In the past, these updates were sent via an email from Outlook. Beginning with the December update, the MCS COVID-19 Stakeholder Update will be sent via GovDelivery.
If you wish to be removed from the MCS COVID-19 Stakeholder Update distribution list and not receive anymore alerts, please reply with “OPT OUT”.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
September 1 Texas Medicaid CHIP COVID-19 Information Session
These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.
The audio from this session can be found here.
The presentation can be found here.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
COVID-19 ICF/IID Webinar Recording from April 11 Available
The April 11 recording of the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Q&A with HHSC Long-term Care Regulation and DSHS is available.
The PowerPoint is updated with information given in the DSHS webinar.
Listen to the webinar recording here.
Email LTCR Policy for the transcrip
COVID-19 ICF/IID Webinar Recording from Feb. 14 Available
A recording of the Feb. 14 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Q&A with HHSC Long-term Care Regulation and DSHS is available for those who could not attend.
There have been changes made to the PowerPoint based on the information provided by DSHS during the webinar.
Listen to the webinar recording.
Email LTCR Policy for the transcript.
HCS, TxHmL COVID-19 Response Webinar Recording: Jan. 27 and Jan. 30
This webinar reviewed information from the revised COVID-19 Response Plan for HCS and TxHmL.
This includes strategies to rapidly identify COVID-19 and:
- Prevent its spread
- Protect individuals, staff, and visitors
- Provide care to infected people
- Recover from an outbreak
They also addressed the surge of COVID-19 across the state, address staffing shortages and provide you guidance from the CDC.
. A recording of this webinar is now available as of Jan. 31 at GoToStage.
HCS and ICF/IID providers who attended the webinar from HHSC on 1/19/22.
- Recently HHSC re-issued and, in some cases, issued updated policies and guidance for all IDD COVID-related documents.(1/5/22 and 1/7/22 for HCS concerning guidance booklet updates).
- HHSC is working to reorganize the COVID-related information, including COVID flexibilities and Appendix K waivers, on the ICF/IID and HCS home webpages to facilitate ease in access.
- HHSC did communicate the above and other changes and policy clarifications with providers via a webinar on January 19th, 2022, however many questions were still unanswered and attendees were told that questions that were not answered should be addressed in an FAQ from HHSC within 2 weeks of the webinar.
Jan. 19 Recording of HCS and ICF/IID COVID-19 Webinar Available
A recording of the Jan. 19 for Home and Community-based Services and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions webinar with LTCR is now available.
Listen to the webinar recording here.
Read the webinar slide presentation (PDF).
Email LTCR Policy for the transcript.
Employment Assistance & Supported Employment Training Options From HHSC
Employment Assistance & Supported Employment Training Options From HHSC
January 12th, 2022
“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 in the community. Various staff from the Local Authority, along with private providers in the area, as well as stakeholder groups will benefit from this training.
With the very high turnover rates the last several years, this training provides the opportunity to garner a basic understanding of Employment First, Employment Services, Benefits and Work Incentives, Job Coaching, Employment Readiness Skills, and Employer Relationships. Service Coordinators will benefit tremendously from this training as they serve as the first line in service planning. Additionally, a myriad of staff such as social workers, employment support staff, direct service staff, case managers, Qualified Intellectual Disability Professionals (QIDP), management staff and many others have found this training valuable. In short, anyone who has a role in supporting an individual directly or indirectly will benefit from the training.
This training will be offered at numerous locations in the state from February thru August 2023. We are pleased to advise that the first two events will be in Houston on February 7th and 8th. Each day will cover the same training, thus only one day should be chosen when registering.
Training will be held at the Harris Center 9401 Southwest Freeway, Houston, Texas 77074 in Conference Room 104, 9am to 4pm. Each event will have a max attendance limit of 70 people. Thus, moving quickly to register will be important. Please help us in getting the word out to your staff as well as sharing with others outside of your organization who can benefit. Registration is easy. Registrants can use one of the two links below based on the best date for the registrant.”
Thank you and we look forward to seeing everyone on February 7th or February 8th!
August 1st, 2021
Live HHSC Training Workshop!
HHSC is announcing a free, one-day Employment First / Employment Services Training event to be offered in six cities from September 2021 thru December 2021. Employment promotes a more independent living setting and creates independence for a person in many ways. This training is another tool to increase the Employment First focus and provide better tools for providers to improve hands-on skills and increase job opportunities for people with intellectual and developmental disabilities.
Training includes:
· Overview of Texas Employment First Policy
· Employment services in Medicaid waivers
· Basic facts on Social Security Administration disability benefits
· Basic facts on developing an employment profile and vocational assessment
· Building connections and working with families
· Development of soft skills and job-readiness skills
· Basic overview of applications and tablets for use as job coaches
· Building and maintaining strong employer relationships
The training is specifically designed for any staff member who has a role in supporting people who set employment goals or people with direct, hands-on roles such as service coordinators, employment specialists, direct care staff, day habilitation staff, job coaches, supervisors and others who support individuals as they pursue competitive and integrated employment.
Registration Links for each event as follows:
*September 8, 2021 – Lubbock – MGM Elegante (801 Avenue Q, Lubbock, TX 79401)
*September 29, 2021 – Austin – Norris Conference Center (2525 W Anderson Ln #365, Austin, TX 78757)
*October 13, 2021 – McAllen – Cambria Hotel McAllen Convention Center (701 South Ware Road, McAllen, TX, 78501)
*November 4, 2021 – San Antonio – Norris Conference Center (618 Northwest Loop 410 STE 207, San Antonio, TX 78216)
*November 17, 2021 – Corpus Christi – Region 2 Education Center (209 N Water St, Corpus Christi, TX 78401)
*December 1, 2021 – El Paso – Region 19 Education Center, (6611 Boeing Dr., El Paso, TX 79925)
Each event is limited to a maximum of 45 registrants. HHSC highly encourages everyone to register early to make certain a space is reserved. HHSC will also offer a waiting list after they reach the maximum capacity for any event, which will be identified to anyone attempting to register once a given event is full. Those on the waiting list will be contacted in the order received if they are notified of a cancellation.
June 28th, 2021
There are two Home and Community-based Services and Texas Home Living trainings in this series:
The web-based trainings cover employment services provided through HCS and TxHmL, information about the payer of first resort for employment assistance, and the basics of providing these services. They are designed to enhance staff knowledge about providing quality employment services to people enrolled in the waivers.
Each training has a corresponding quiz.
The Direct Service Workers web-based training provides information about employment services and how direct service workers can support people achieve their employment goals. The training covers federal and state initiatives related to employment for people with disabilities and touches on issues related to people who work and receive SSI or SSDI benefits. The training has a corresponding quiz.
EVV (Electronic Visit Verification) Updates
January 12th, 2023
Electronic Visit Verification (EVV) for Individualized Skills and Socialization (ISS) IL-2023-03 alert letter
Electronic Visit Verification (EVV) for Individualized Skills and Socialization
Program providers must ensure EVV is used when delivering in-home individualized skills and socialization in an own home/family home (OHFH) setting. For dates of services on and after March 1, 2023,
HHSC will deny or recoup a claim for in-home individualized skills and socialization in the own home/family home setting without a matching EVV visit record. For more information about EVV claims matching, refer to the EVV notice, “EVV Claims Matching for HCS and TxHmL Starts March 1, 2023”.
Program providers must input the Texas EVV Attendant ID for in-home EVV individualized skills and socialization OHFH claims.
Email TMHP EVV Operations for questions or refer to the document, HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF), for more information to help avoid EVV claim mismatches.
to the LTC Billing Crosswalk for more information about Staff ID requirements.
By January 13, 2023, HHSC will update the EVV Personal Care Services Bill Codes Table, located on the HHSC EVV web page, to include the specific Individualized Skills and Socialization billing codes which require EVV. Sign up for EVV GovDelivery to receive updates by email.
For EVV-related contact information, reference the EVV Contact Information Guide for Program Providers and FMSAs (PDF).
To read more, please click on link below, for Information Letter 2023-03 related to ISS automatic service authorizations and EVV
January 2nd, 2023
EVV Vendor Systems Will Display Individualized Skills and Socialization Services Starting 1/1/2023 Before New Authorizations Are Available
This notice is for Home and Community-based Services program providers, Texas Home Living program providers and financial management services agencies required to use Electronic Visit Verification.
As shared in the EVV notice published on Oct. 26, Individualized Skills and Socialization bill codes will replace day habilitation bill codes; therefore, the EVV vendor systems will display 1/1/23 as the effective date for these new services; however, HHSC has extended the date when the new authorizations for Individualized Skills and Socialization services will be available, which is the week of 1/9/23.
Program providers and FMSAs required to use EVV must continue to use EVV.
HHSC will continue posting related updates.
As a reminder, EVV claims matching for HCS and TxHmL starts March 1, 2023. EVV Operations will be posting the updated bill codes, including helpful information to avoid future payment denials or recoupments, following the publication of other HHSC materials.
For other EVV questions, email the EVV Operations inbox.
For questions about Individualized Skills and Socialization services, email the Long-Term Services and Supports Policy inbox.
December 17th, 2022
EVV Training Updates
This notice from HHSC lists Electronic Visit Verification training updates for program providers, financial management services agencies and Consumer Directed Services employers required to use EVV.
Resources from the following training webinars are now available in the HHS Learning Portal by selecting EVV Policy Training – Webinar Recordings FY23:
- Español – EVV Compliance for CDS Employers (PDF) – Aug. 25 non-required training webinar
- Annual EVV Policy Training for Program Providers and FMSAs – Sept. 30 and Oct. 27 webinars
If new to EVV and need to complete the EVV policy training requirement, complete one of the applicable computer-based training courses located in the HHS Learning Portal:
- EVV Policy Training for Program Providers and FMSAs FY23
- Initial EVV Policy Training for CDS Employers FY23
An account is required to access the training webinar resources and CBTs, including to obtain a certificate of completion. Note that a “non-required training” does not include a completion certificate because it is considered optional training. Reference the EVV HHS Learning Portal Guide (PDF) for instructions.
For more information on EVV training requirements, reference section 4200 from the EVV Policy Handbook.
Sign up for GovDelivery to receive EVV updates, such as training updates, by email.
Email EVV Operations for questions.
2023 EVV Operational Readiness Review Session & Business Rules for Proprietary Systems Version 3.0
EVV Operations has posted the following notice: Notice of 2023 EVV Operational Readiness Review Sessions and EVV Business Rules for Proprietary Systems Version 3.0 (PDF).
This notice is to inform program providers and financial management services agencies about the publication of the 2023 Operational Readiness Review Sessions, as well as the new EVV Business Rules for Proprietary Systems Version 3.0.
EVV Guidance on Program and Service Requirements for Schedules
HHSC has published the document, Program and Service Requirements for Schedules (PDF), under the Resources section on the Electronic Visit Verification web page. This document describes HHSC requirements related to using schedules in the EVV system.
Email HHSC EVV Operations for questions.
December 1st, 2022
Reminder for STAR+PLUS, STAR Kids and STAR Health: New EVV Bill Codes and Modifier Combinations Effective Dec. 1
As a reminder, starting Dec. 1, new Electronic Visit Verification personal care services Healthcare Common Procedure Coding System and modifier combinations will be effective for:
- STAR+PLUS
- STAR Kids
- STAR Health
Refer to HHSC’s Oct. 31 notice for more information.
Contact your managed care organization for questions about these updates. Refer to the last page of the EVV contact guide (PDF) for MCO contact information.
December 1st, 2022
HCS and TxHmL Updates
The effective dates were updated for HCS and TxHmL services.
Refer to the bill codes table’s revision history dated Dec. 1, 2022, for more information.
For questions, email EVV Operations.
October 16th, 2022
Potential Electronic Visit Verification Changes Coming in 2023
The purpose of this notice is to inform stakeholders that HHSC’s contract for the current Electronic Visit Verification vendor systems (AuthentiCare and Vesta EVV) is scheduled to expire on Aug. 31, 2023.
On April 26, 2022, HHSC posted a competitive solicitation on the Electronic State Business Daily for EVV System Management Services. Contractor responsibilities will include:
- Providing and managing a single EVV vendor system
- Review and approval of provider-operated EVV proprietary systems If you have an outside vendor (proprietary vendor), these will be reviewed as well.
- Coordinating EVV system integration with the EVV aggregator
- Providing operational and technical support for the functions listed above
Notification of contract award is anticipated in March 2023.
HHSC, at its sole discretion, may publish updates about the anticipated award date to the Procurement Forecast on the HHS Procurement Opportunities web page. Respondents are responsible for periodically checking the ESBD and the HHSC Procurement Forecast web page for updates.
HHSC must maintain the confidentiality and integrity of the procurement process; therefore, no additional information is available at this time. HHSC will provide more information in future announcements.
Email questions about this solicitation to Andrick Reese.
September 25th, 2022
EVV Updates for HCS and TxHmL Program Providers and FMSAs
HHSC and the Texas Medicaid and Healthcare Partnership posted helpful information for Home and Community-based Services program providers, Texas Home Living program providers and financial management services agencies required to use Electronic Visit Verification.
HHSC Notice
This notice is to help program providers and FMSAs that are receiving EVV mismatches for Day Habilitation services.
Refer to the Sept. 15 notice for information on billing requirements, such as which Day Habilitation bill codes to use.
TMHP Notice
This notice provides information about EVV requirements for In-Home Day Habilitation and about EVV claims matching starting Nov. 1 for HCS and TxHmL.
Refer to the Sept. 19 notice for more information and resources.
Email EVV Operations for questions.
September 25th, 2022
EVV Claims Matching Refresher for HCS and TxHmL
Electronic Visit Verification claims matching for Home and Community-based Services and Texas Home Living will begin for dates of service starting Nov. 1.
To help prepare, the Texas Medicaid and Healthcare Partnership will host a refresher webinar on Oct. 13, for:
- HCS program providers
- TxHmL program providers
- Financial management services agencies
Refer to TMHP’s Sept. 15 notice for more information and to registerl
Click here for more information
September 18th, 2022
EVV Compliance Job Aids Updated
The Electronic Visit Verification Compliance Job Aids have been updated. They are in the compliance section on the EVV web page.
The job aids were simplified and provide updated information about the following EVV Compliance standards:
- EVV Usage Scores and reviews
- Required free text reviews
- Landline phone verification reviews
August 31st, 2022
Annual EVV Policy Webinars for Program Providers & FMSAs
July 28th, 2022
EVV Portal and Training Updates
Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on July 14.
Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information.
July 5th, 2022
EVV Claims for HCS and TxHmL Will Deny for Dates of Service Starting Sept. 1
HHSC has extended the start date when Electronic Visit Verification claims for Home and Community-based Services and Texas Home Living will deny for no matching EVV visit. This will begin for the dates of service of Sept. 1, 2022, and after.
The extension gives HCS and TxHmL program providers and financial management services agencies more time to improve their claims matching. Texas Medicaid and Healthcare Partnership will provide more outreach and training on this topic. Trainings will be announced at a future date.
Refer to the HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF) for technical guidance.
HCS and TxHmL EVV claims must continue to be submitted through the Client Assignment and Registration System or TMHP.
- Submit EVV claims to CARE for dates of service before May 1, 2022.
- Submit EVV claims to TMHP for dates of service of May 1, 2022, and after.
Program providers, FMSAs and Consumer Directed Services employers must continue to use EVV during this period. However, HCS and TxHmL claims will not be denied for an EVV mismatch. HCS and TxHmL claims during this period are still subject to HHSC provider fiscal compliance reviews conducted by HHSC Provider Fiscal Compliance..
Email EVV Operations for questions.
July 1st, 2022
EVV Claims for HCS and TxHmL Will Deny for Mismatched Visits Starting July 1
Starting July 1, Electronic Visit Verification claims for Home and Community-based Services and Texas Home Living must have a matching EVV Visit, or claims will deny.
Refer to the June 20 notice for more information and resources.
Email EVV Operations for questions.
June 12th, 2022
EVV Portal and Training Updates
Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on June 9.
There are also two new visit rejection codes related to EVV system transfers.
Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information.
June 6th, 2022
EVV Policy Handbook Revision and Training Updates
The Electronic Visit Verification Policy Handbook has been revised.
Revisions include:
- Adding new sections for the Consumer Directed Services option.
- Updating Schedules policy.
- Updating Visit Maintenance Reduction Features policy.
These revisions are effective June 1 and are outlined in the new revision log (PDF), located on the EVV webpage.
The handbook’s policies include EVV standards and policy requirements for:
- Program providers
- Financial Management Services Agencies
- Consumer Directed Services employers
- Payers, such as HHSC and managed care organizations
Computer-based training on the HHS Learning Portal were updated to include the policy revisions.
- EVV Policy Training for Program Providers and FMSAs CBT
- Initial EVV Policy Training for CDS Employers CBT
- Note: The updates to the Spanish CBT will publish in June.
Email HHSC EVV Operations for questions about this notice.
May 30th, 2022
EVV Claims Matching for HCS and TxHmL Will Resume July 1
Electronic Visit Verification claims matching will resume for all Home and Community-based Services and Texas Home Living billing code combinations with dates of service of July 1, 2022 or after.
HHSC will post another notice with more information and resources to avoid EVV claims mismatches before July 1, 2022.
Email EVV Operations for questions about this notice.
May 8th, 2022
EVV Portal and Training Updates
Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on April 29.
Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information.
Email TMHP EVV Operations with questions
March 7th, 2022
EVV Notice for HCS/TxHmL Program Providers
The migration of Home and Community-based Services (HCS) and Texas Home Living (TxHmL) forms and claims entry to Texas Medicaid & Healthcare Partnership (TMHP) has been moved from March 1, 2022, to May 1, 2022. The postponement allows more time for program providers to set up the necessary TMHP accounts and take relevant training courses. HCS and TxHmL program providers must continue to use the Client Assignment and Registration (CARE) system to submit claims using existing billing code combinations for service groups 12 and 15 for dates of service prior to May 1, 2022.
HHSC is aware that some program providers updated authorizations in the EVV systems to reflect the new billing code combinations for service groups 21 and 22 that were scheduled to take effect March 1. To avoid the re-entry of authorizations, HHSC and TMHP will take the following actions:
- By March 4, the EVV Aggregator will accept billing code combinations for service groups 12, 15, 21 and 22 on EVV visits for dates of service through April 30, 2022, to prevent visit rejections.
- For dates of service on or after May 1, 2022, the EVV Aggregator will only accept billing code combinations for service groups 21 and 22.
- Turn on the EVV07 claims matching bypass for all HCS and TxHmL billing code combinations to avoid claim denials through May 31, 2022.
- Claims matching for all HCS and TxHmL billing code combinations will resume June 1, 2022.
- Publish an updated EVV Service Bill Codes Table to reflect these changes.
HCS and TxHmL claims will not be denied for an EVV mismatch. HCS and TxHmL claims during this period are still subject to HHSC provider fiscal compliance reviews conducted by HHSC Provider Fiscal Compliance.
**For visits that have been rejected by the aggregator due to incorrect billing code combinations, program providers must re-export the visit and ensure it is accepted in the EVV aggregator prior to submitting claims.
Please refer to HHSC’s ‘Continue Submitting Claims and Forms Using CARE System Until May 1, 2022’ notice for more information.
For technical questions related to the EVV Aggregator, contact TMHP. For other general EVV inquiries, contact HHSC EVV Operations.
March 3rd, 2022
EVV Policy Handbook Revisions Now Available
HHSC revised sections and appendices of the Electronic Visit Verification Policy Handbook.
The handbook includes EVV standards and policy requirements for:
- Program providers.
- Financial Management Services Agencies.
- Consumer Directed Services employers.
- Payers, such as HHSC and managed care organizations.
The revisions are effective March 1 and are briefly described in the 22-2 notice. For more information about the policy changes, refer to the new revision log (PDF) located on the EVV webpage.
Email HHSC EVV Operations with questions.
February 28th, 2022
EVV Portal and Training Updates
Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on Feb. 28.
For more information, refer to the EVV Portal and Training Updates article on TMHP’s EVV webpage.
For questions, email TMHP EVV Operations.
January 8th, 2022
EVV Policy Handbook Revisions – Jan. 7th, 2022
HHSC revised parts of the Electronic Visit Verification Policy Handbook. These revisions are effective Jan. 7 and are listed in Revision Notice 22-1.
The handbook’s policies include EVV standards and policy requirements for:
- Program providers.
- Financial Management Services Agencies.
- Consumer Directed Services employers.
- Payers, such as HHSC and managed care organizations.
For questions, email HHSC EVV Operations.
November 21st, 2021
EVV Portal and Training Updates for November 2021
Texas Medicaid and Healthcare Partnership made improvements to the EVV Portal and related training materials on Nov. 11.
For more information, access the November 2021 EVV Portal and Training Updates article on TMHP’s EVV webpage.
FYI- When you click on the link above for updates from HHSC, please be sure to scroll to the bottom and click on “accept” as this is a disclaimer page. You must do this 1st. I have received some comments that some providers get confused when they see this page on the EVV website first pop up and they think they are on the wrong page, or there is a problem with the website page, etc…
Email TMHP with questions about these updates.
November 18th, 2021
Revised EVV Policy Handbook Now Available
The Electronic Visit Verification Policy Handbook was revised.
The handbook’s policies are effective Nov. 1, 2021 and include EVV standards and policy requirements for:
- Program providers
- Financial Management Services Agencies
- Consumer Directed Services employers
- Payers such as HHSC and managed care organizations
The handbook replaces policies previously on the HHSC EVV webpage. See EVV Policy Handbook Revisions – November 2021 (PDF) for differences between previously published policies and the revised handbook.
The following computer-based training courses on the EVV Training page of the HHS Learning Portal now reflects the revised EVV Policy Handbook:
- Initial EVV Policy Training for CDS Employers
- EVV Policy Training for Program Providers and FMSAs
Use the applicable checklist within EVV Training Requirements Checklist (PDF) for EVV training requirements and completion options.
Email questions to HHSC EVV Operations.
November 17th, 2021
EVV Visit Maintenance Unlock Request Updates
HHSC published EVV Visit Maintenance Unlock Request spreadsheet updates.
These updates let the user request corrections to data element(s) on an EVV visit transaction(s) after the visit maintenance time frame has expired.
Program providers, Financial Management Services Agencies and Consumer Directed Services employers must use the request spreadsheets found on the EVV webpage.
The updates to the program provider and FMSA Request (Excel) include:
- New fields
- Added drop-down lists to applicable fields
- Updated and simplified field headers
- Revised instructions to:
- Reflect EVV policy updates
- List detailed steps and notes to complete the Request
The new Request for Consumer Directed Services employers (Excel) include:
- A new request spreadsheet for CDS employers who selected Option 1 on Form 1722, Employer’s Selection for EVV Responsibilities, to complete visit maintenance. This includes:
- Drop-down lists for applicable fields
- Sections for CDS employers and payers to complete
- Instructions reflect:
- EVV policy updates
- Detailed steps and notes to complete the request
Review the instructions on the spreadsheets for more information.
Email questions to your payer, either HHSC or a managed care organization
July 4th, 2021
EVV Visit Maintenance Policy Now Available
The Electronic Visit Verification Visit Maintenance Policy (PDF) is now available on the HHSC EVV webpage. The policy is effective July 1, 2021 and:
- Requires the program provider, Financial Management Services Agency or Consumer Directed Services employer to ensure each EVV visit transaction is complete, accurate and validated.
- Incorporates the Visit Maintenance: Last Visit Maintenance Date Policy.
- Incorporates the Visit Maintenance Unlock Request Policy.
- Includes the new visit maintenance time frame of 95 calendar days. (previously 60 calendar days) from the date of service delivery.
Email questions to HHSC EVV Operations at EVV@hhs.texas.gov.
July 4th, 2021
HHSC EVV Webpage Updates Now Available
The Texas Health and Human Services Commission updated and archived web sections and content, updated and added additional information related to the 21st Century Cures Act (Section 12006) and added new resources for the following Electronic Visit Verification webpages:
- EVV Home page,
- EVV Consumer Directed Services Option,
- EVV Cures Act,
- EVV Training and
- EVV Proprietary Systems.
Email questions to HHSC EVV Operations at EVV@hhs.texas.gov.
July 3rd, 2021
Revised EVV Visit Transaction Rejection Guide Now Available
The Electronic Visit Verification Visit Transaction Rejection Guide (PDF) was revised and is now available.
The guide provides step-by-step instructions for program providers and Financial Management Services Agencies to identify and correct issues that result in transaction rejections in the EVV system.
The guide is published on TMHP’s EVV Training webpage.
April 17th, 2021
EVV Policy Training for CDS Employers Now Available in Spanish
The computer-based training course, Initial EVV Policy Training for CDS Employers, is available in Spanish on the HHS Learning Portal.
To translate the HHS Learning Portal to Spanish, select Español from the drop-down menu in the upper left-hand corner of the webpage.
The policy training is tailored to the selection on Form 1722, Employer Selection for Electronic Visit Verification Responsibilities.
Registrants are not required to complete the Form 1722 Pre-Course Survey.
Follow the instructions throughout the course to complete and receive certification.
Email the HHSC EVV Mailbox for questions about EVV policy training.
March 16th, 2021
HHSC Publishes EVV Requirements of Signatures on Enrollment Documentation (IL 2021-13)
HHSC has published IL 2021-13, EVV Notification Requirement (PDF), replacing IL 2020-01.
The letter addresses revisions on instructing LIDDAs on the requirements of signatures on enrollment documentation.
It also addresses new activity requirements for HCS, TxHmL, CDS program providers and LIDDA service coordinators.
For questions, email HCS Policy or CDS.
March 10th, 2021
Temporary EVV Policies for the Feb. 2021 Severe Winter Weather
In response to the recent severe winter weather, HHSC issued Temporary EVV Policies for Severe Winter Weather (PDF).
The flexibilities are for dates of service from Feb. 10, 2021 through Feb. 24, 2021.
The flexibilities are for program providers, financial management services agencies and consumer directed services employers required to use EVV.
Email questions to the HHSC EVV Mailbox.
February 7th, 2021
EVV Refresher Training on Feb. 19
The Texas Health and Human Services Commission and Texas Medicaid & Healthcare Partnership are hosting an Electronic Visit Verification webinar.
This training is a refresher and covers topics for Home and Community-based Services program providers, Texas Home Living program providers and financial management services agencies who submit EVV claims for HCS and TxHmL EVV-required services.
The training is not required and is not a substitute for annual EVV training requirements.
Certificates of completion will not be issued.
Attendees will have the opportunity to submit questions throughout the training.
Both HHSC and TMHP will conduct a live question and answer session.
The registration link is below and provides details, such as agenda topics.
HCS/TxHmL EVV Refresher Training – Claims Submission/Claims Matching Policies & Best Practices to Avoid EVV Claim Mismatches
Friday Feb. 19
10 a.m. – Noon
Register for the webinar.
Reminder: Entering Schedules for EVV-Required Services
The Electronic Visit Verification system allows Home and Community-based Services, Texas Home Living program providers, CDS Employers and Financial Management Services Agencies to enter schedules for EVV-required services. This is not an HHSC requirement. Program Providers, FMSAs and CDS employers can choose to enter a schedule into the EVV system.
EVV is only required for the following services:
- Community First Choice Personal Assistance Services/Habilitation
- In-Home Day Habilitation in own home or family home settings
- In-Home Respite in own home or family home settings
Email hcspolicy@hhsc.state.tx.us or txhml@hhsc.state.tx.us with questions.
January 24th, 2021
EVV Portal and Training Updates for January
On Jan. 14, Texas Medicaid & Healthcare Partnership made improvements to the Electronic Visit Verification Portal by updating the EVV Reason Code Usage and Free Text Report and updated the related training materials.
Read the TMHP article EVV Portal Improvements and Training Updates for details.
Email TMHP with questions about these updates.
January 24th, 2021
HCS & TxHmL Best Practices to Avoid EVV Claim Mismatches for CFC PAS/HAB Services
HHSC has published Best Practices to Avoid Electronic Visit Verification Claim Mismatches for Home and Community-based Services and Texas Home Living (PDF) program providers and financial management services agencies.
The best practices help HCS and TxHmL providers avoid claim denials related to EVV.
The best practices are linked above and on the HHS EVV Training webpage in the Best Practices section.
Email questions about EVV policy to HHSC EVV.
January 18th, 2021
EVV Compliance Oversight Reviews Delayed for EVV Usage and Misuse of EVV Reason Codes
HHSC told managed care organizations to delay compliance oversight reviews for EVV Usage and Misuse of EVV Reason Codes. Evaluation of visit data collected during the grace period ensures the compliance measures continue to align with current EVV policy.
EVV Usage and Misuse of EVV Reason Codes reviews for the compliance grace period ended on Aug. 31, 2020 for:
- EVV visits with Sept. 1, 2019 to Aug. 31, 2020 dates of service.
- Program providers required to use EVV by state law before the Cures Act Implementation identified on pages 3 and 4 of the Programs and Services Required to Use EVV (PDF) document.
Next Steps
- HHSC will notify program providers 90 calendar days before reviews begin for EVV Usage and Misuse of EVV Reason Codes for EVV visits with dates of service on and after Sept. 1, 2020.
- HHSC and MCOs will continue reviews for EVV Landline Phone Verification and Required Free Text.
- Program providers can use the EVV Usage Report, and EVV Reason Code Usage and Free Text Report in the EVV Portal to track these compliance measures.
Program providers can contact their payer or email HHSC EVV with their questions or concerns.
January 10th, 2021
EVV Notification Requirement for HCS/TxHmL Program Providers
HHSC has published IL 2021-01 Electronic Visit Verification Notification Requirement (PDF).
The letter informs HCS and TxHmL program providers they are now required to use the EVV system for CFC PAS/HAB, in-home respite, and day habilitation provided in the home of an individual who has a residential location of “own/family home.”
Texas Government Code, §531.024172(c), requires that HHSC inform an individual who receives a service requiring the use of EVV that the individual is required to comply with the EVV system. HHSC has developed a form for providers to comply with this statute.
The Electronic Visit Verification Responsibilities and Additional Information form is included with the IL 2021-01 (PDF).
January 4th, 2021
EVV for HCS and TxHmL providers has gone live since January 1, 2021 (includes CDS and FMSA’s)
Resources for providers, including escalation processes, regarding EVV questions & concerns:
- HHSC EVV Operations and TMHP have developed two Contact Guides:
- To assist program providers and FMSAs identify and correct EVV visit transaction rejections, TMHP created the EVV Visit Transaction Rejection Guide (PDF).
- Email HHSC EVV Operations, Electronic_Visit_Verification@hhsc.state.tx.us, regarding:
- EVV Policy and Compliance Questions
- General EVV Inquiries and Complaints
- Good idea to CC your provider association, if you are a member (PPAT, PACSTX..)
- Email TMHP, EVV@tmhp.com, regarding TMHP issues and EVV vendor complaints/issues.
- Copy Evan Wilkerson on urgent TMHP or EVV vendor issues.
December 20th, 2020
Cures Act EVV:
Preparing for Jan. 1, 2021 Implementation
HHSC will require Electronic Visit Verification for all Medicaid personal care services beginning on Jan. 1, 2021. This requirement is mandated by the federal 21st Century Cures Act. If HHSC does not comply, Texas will lose federal funding for Medicaid services.
Beginning Jan. 1, 2021:
- Document all delivery visits for an EVV-required service in the EVV system. EVV-required services on the Programs, Services, and Service Delivery Options Required to Use EVV (PDF) document.
- An EVV-required service claim will be paid only if:
- The EVV visit transaction that supports the claim is accepted into the EVV Portal before claim submission.
- The claim receives an “EVV01 – EVV Match” result code in the EVV Portal after the claims matching process is performed.
Program providers and financial management services agencies must complete the following before Jan. 1, 2021, to avoid impacts to EVV claims payment:
- EVV system onboarding. This includes system setup and training.
- If an EVV vendor system is selected from the state vendor pool, the EVV vendor provides the training. Refer to the TMHP EVV Vendors webpage for more information about EVV vendors and their contact information.
- If an EVV proprietary system is selected, the program provider or FMSA handles system training.
- EVV training requirements outlined in the Cures Act EVV: Training Requirements Checklists (PDF).
- Document all visits for EVV-required services in the EVV system.
CDS employers must complete the following before Jan. 1, 2021, to avoid delays in payment to their CDS employees:
- Form 1722, Employers Selection for Electronic Visit Verification Responsibilities. Submit the signed form to their FMSA, which is the company that helps with CDS employee payroll.
- EVV system onboarding. CDS employers can contact their FMSA to complete onboarding and schedule training.
- EVV training requirements outlined in the Cures Act EVV: Training Requirements Checklists (PDF).
- Employees must start documenting all visits for EVV-required services in the EVV system.
HHSC is providing the following support to program providers, FMSAs, and CDS employers. This is to reduce impacts to claims payment and payment to CDS employees as they adjust to the new EVV requirements.
- If a visit is not captured through an electronic verification method, enter the visit manually into the EVV system and confirm acceptance into the EVV Portal to avoid claim denials. Instructions for manually entering a visit are posted in the following locations:
- DataLogic/Vesta EVV system.
- First Data/AuthentiCare EVV system in the “Custom Links” section.
- HHSC has published Best Practices to Avoid EVV Claim Mismatches (PDF) to help program providers and FMSAs ensure a claim is not denied for reasons related to EVV.
- HHSC has issued the 90 Day Visit Maintenance Temporary Policy (PDF). extending the time to complete visit maintenance for dates of service between Jan. 1, 2021 and March 31, 2021.
- An EVV compliance grace period will be applied for one year to all Cures Act EVV Expansion services with dates of service between Jan. 1, 2021 and Dec. 31, 2021 for the compliance measures listed in EVV Compliance Oversight Reviews Policy (PDF).
The EVV Contact Information Guides provide points of contact for EVV-related questions and issues:
- CDS Employer EVV Contact Information Guide (PDF)
- Program Provider and FMSA Contact Information Guide (PDF)
Visit the HHS EVV website for more information.
November 28, 2020
HCS and TxHmL CARE Service Authorization instructions for EVV
HCS and TxHmL are required to manually enter each individual’s service authorization in the EVV Vendor System.
Providers can find instructions here on how to find their service authorizations in CARE.
If additional assistance is needed after the service authorization is obtained, program providers can contact their EVV vendor for further instructions.
Existing EVV Users: Temporary EVV Policies for COVID-19 to End Dec. 31
HHSC is extending the Temporary EVV Policies for COVID-19 (PDF) through Dec. 31, 2020 for program providers currently required to use Electronic Visit Verification. HHSC will end the temporary policies after Dec. 31, 2020.
Program providers submitting EVV claims for dates of service on and after Jan. 1, 2021:
- Must ensure a matching EVV visit transaction is accepted in the EVV Portal before billing the claim, or the claim will be denied.
- Will no longer receive an EVV07 match code in the EVV Portal.
- Will no longer have 180 days to complete visit maintenance.
Reminder: HHSC extended the practice period for the Cures Act Expansion. Claims for EVV services included in the Cures Act Expansion, will be denied without a matching EVV visit transaction for dates of service on and after Jan. 1, 2021.
Best Practices for Temporary EVV Policies for COVID-19
Program providers should continue to follow the Best Practices for Temporary EVV Policies for COVID-19 (PDF) to avoid recoupments for claims submitted between March 21, 2020 and Dec. 31, 2020.
Contact your payer for questions or email HHSC EVV.
HCS and TxHmL Program Providers Required to Select an EVV Vendor | ||||||||
11/18/2020 | ||||||||
|
Deadline Approaching Soon!!
Remember everyone: Effective Dec. 1, HHSC will require HCS and TxHmL program providers to use EVV for the following services:
- Community First Choice Personal Assistance Services/Habilitation (CFC PAS/HAB)
- In-Home Respite
- In-Home Day Habilitation (Own Home or Family Home only)
HCS and TxHmL program providers are required to select an EVV vendor and complete EVV training to meet the Dec.1 deadlines. The requirement to select an EVV vendor and complete training applies to all contracted HCS and TxHmL program providers.
Beginning Dec. 1, 2020, service claims for CFC PAS/HAB will be denied by the claims adjudication system and not paid by HHSC if the program provider has not onboarded with an EVV vendor.
Click here to read IL 20-07 (PDF) for more information about selecting an EVV vendor and completing training to be EVV-compliant by the Dec. 1 deadline.
Contact EVV if you have questions about EVV requirements.
Oct. 11th, 2020
EVV Revised Policies Effective Oct. 1
HHSC has revised the following electronic visit verification policies, effective Oct. 1. The information is for program providers and financial management services agencies. It is on the Policy section of the HHS EVV webpage.
The policy:
- Includes additional EVV claims match result codes
- Identifies exceptions to the claims matching process
Claims Submission Policy (PDF)
- The policy includes detailed information about the requirement to submit claims for EVV-required services to the appropriate HHSC claims management system.
- The EVV Billing Policy has been incorporated into the policy.
Email HHSC EVV with your questions.
Oct. 11th, 2020
Updated EVV Service Bill Codes Table Effective Oct. 1
The EVV Service Bill Codes Table is updated effective Oct. 1. The table is on the HHS EVV webpage in the Service Bill Codes Table section. See:
- Below for the major updates
- The Revision History in the table for a complete list of the changes
Program providers and FMSAs can refer to the table for the list of EVV-relevant services and bill code information to avoid EVV visit transaction rejections and EVV claim mismatches.
Units Matching
The updated table shows that during the EVV claims matching process for dates of service on and after Oct. 1, billable units on the EVV visit transaction will be matched to billed units on the claim for:
- EVV-relevant services delivered through the service responsibility option in Managed Care and fee-for-service Long-Term Care programs.
- Community First Choice Personal Assistance Services/Habilitation in the Community Living Assistance and Support Services program (Service Group 2, Service Code 10CFC T2026).
Home and Community-based Services and Texas Home Living Programs
- The table clarifies the EVV Requirements for In-Home Day Habilitation in the HCS Program when In-Home Day Habilitation and In-Home Respite services are provided in a member’s own home or family home setting.
- The “Claims Place of Service” column in the “CARE LTC FFS” tab only includes place of service code 12 (Home Location) because EVV is only required to capture services that need an in-home visit.
HHSC is issuing this guidance from CMS to Home and Community-based Services program providers. It clarifies electronic visit verification requirements for in-home day habilitation.
All service events occurring on or after Dec. 1, 2020, for an EVV-required service, must be captured in the EVV system and accepted into the EVV Aggregator.
EVV is not required for In-Home Day Habilitation provided to someone in a:
- Three or four-person home
- Host home
- Companion care residential setting
EVV is only required for the following services:
- Community First Choice Personal Assistance Services/Habilitation
- In-Home Day Habilitation in own home or family home settings
- In-Home Respite in own home or family home settings
See IL 20-07 Electronic Visit Verification in the HCS and TxHmL Program (PDF) for information about EVV requirements.
Additional Guidance on Day Habilitation Services
Program providers billing claims for In-Home Day Habilitation services requiring EVV will continue to use the current claims procedure code, T2020. The EVV Service Bill Codes Table lists this code on the HHS EVV website.
HHSC is developing separate bill codes for Out-of-Home Day Habilitation and will provide guidance before implementing the new codes.
Email hcspolicy@hhsc.state.tx.us with questions.
No EVV For In-Home DH: 3 & 4-bed Homes or Host Homes
August 20th, 2020
HHSC just informed the three IDD associations that it received clarification from CMS that EVV will not be required for in-home day habilitation delivered in a three- or four-bed home or host home. HHSC will send notice regarding this to all affected stakeholders. This does however mean that In-Home DH provided in an individual’s “Own Family Home” will still require staff to utilize EVV.
CURES Act EVV Training is Underway for HCS/TxHmL Providers
Program providers and FMSAs affected by the Cures Act EVV expansion must complete EVV policy and EVV Portal training before Dec. 1, 2020, and then annually. See the EVV Required Training Checklist (PDF) for more information.
To meet the training requirement, program providers and FMSAs attending these webinars must:
- Register for Session 1.
- Register for Session 2.
- Attend both sessions from start to finish.
To register, click the links below:
FMSAs
- Session 1 – June 2, 2020 – 8:30 a.m. to 12:30 p.m.
- Session 2 – June 3, 2020 – 8:30 a.m. to 12:30 p.m.
HCS/TxHmL
Additional Training Opportunities
Program providers and FMSAs can also meet training requirements by completing computer-based training online in the HHSC Learning Portal and TMHP Learning Management System. HHSC and TMHP are planning additional live training events this fall and will provide more information when available.
Email TMHP for questions about registration or the EVV Portal.
Email questions about EVV training requirements.
For more Cures Act information, visit the HHS EVV Cures Act webpage.
If you miss the EVV training dates, you may take them on the HHSC learning portal:
https://learningportal.dfps.state.tx.us/
Please go to HHSC’s page on Electronic Visit Verification for the latest information/ updates to EVV. Please see Training & Joint Training pages from HHSC as well!
https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/electronic-visit-verification
Updated Timeline for Cures Act EVV Expansion
The updated timeline for expanding the Cures Act EVV requirement to all Medicaid personal care services is now available on the HHS Cures Act EVV website.
The timeline includes new information and resources about the EVV Practice Period beginning July 1, completing training requirements, and more.
This information is for Cures Act program providers and FMSAs (PDF) required to use Electronic Visit Verification by Jan. 1, 2021.
-
-
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 (PDF)
For questions about EVV vendors, email evv@TMHP.com
-
New EVV Proprietary System Onboarding Documents Available
TMHP has posted new information about the EVV proprietary system onboarding process on the TMHP EVV Proprietary Systems webpage.
The documents located in the Onboarding section provide an overview of the approval process that a program provider or FMSA must complete before using their own EVV proprietary system. For more information, refer to the article on the TMHP EVV website (PDF).
Resources
- Contact: Electronic_Visit_Verification@hhsc.state.tx.us
- Website: HHSC EVV Cures Act
Trainings Available:
EVV Policy Training (Provided by your payer)
- The HHSC EVV Policy computer-based training (CBT).
- The MCO Policy training. Contact your MCO for EVV Policy training opportunities.
EVV Aggregator and EVV Portal Training (Provided by TMHP)
There will also be instructor-led trainings (EVV Roadshow) in October. Find the schedule and register on the HHS Learning Portal.
Additional training resources are available on the HHSC EVV website and the TMHP EVV Provider Training webpage.
For questions about this alert, email Electronic_Visit_Verification@hhsc.state.tx.us.
Online, interactive EVV training courses are available
in the HHS Learning Portal and TMHP Learning Management System. Completing these courses help program providers meet EVV training requirements.
The HHS Learning Portal includes training about HHSC EVV Policy.
The TMHP Learning Management System includes training about:
- EVV Vendor Selection
- EVV Portal
- EVV Portal Standard Reports and Search Tools
- EVV Claims Submission and Billing
Public Health Emergency (PHE) Renewed
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, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021, July 19, 2021, October 15, 2021, January 14, 2022, April 12, 2022, July 15, 2022, and October 13, 2022, that a public health emergency exists and has existed since January 27, 2020, nationwide.”
From the HHSC ASPR website page, this is the alert concerning continuing PHE. At this time we have no further information on how long this will be ongoing.
ISS Rates
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.
- The revised Individualized Skills and Socialization payment rates for these programs can be accessed on the Provider Finance Department Long-term Services & Supports webpage.
- The Long-term care HHSC Bill code Crosswalks which is used to match the Texas Long-term Care (LTC) Local Codes (i.e., bill codes) to the National Standard Procedure Codes (e.g., procedure, item, revenue codes) and claim payment for services is available on the HHSC Long-term Care Bill Code Crosswalk page.
Contact PFD-LTSS@hhs.texas.gov or (737) 867-7817 if you have questions.
December 06, 2022
Last Friday HHSC posted the ISS rates which may be viewed at the link below.
- 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
The recording can be accessed on-demand after the hearing at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings.
STATUS OF HCS RATES!
Status of HCS Rates as of Jan. 1st, 2023 (includes new ISS rates)
HCS Rates Jan. 1st, 2023 including ISS services
Status of HCS Rates as of June 3rd 2022
Provider Rate Updates for HCS and TxHmL Providers
In early May, HHSC identified missing or incorrect rate keys for some Home and Community-based Services and Texas Home Living providers.
On May 11–12, HHSC completed updates to rate keys for these HCS and TxHmL providers based on rates published on the Provider Finance website.
After confirming rates with Provider Finance and paid claims on the R&S Report, contact the TMHP LTC Help Desk at 800-626-4117, Option 1, then Option 7, if you have additional questions.
https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2022/2022-hcs-awards.pdf
Status of HCS Rates as of January 17th, 2022
HCS and TxHmL Day Habilitation Rates, Respite Rates and Other Concerns
- The Public Health Emergency (PHE) was renewed until April 16, 2022, and
- Clarification: The HCS & TxHmL rates posted on HHSC’s webpage listed as Effective March 1, 2022 to Current. are a bit confusing
Please contact the Rate Analysis Department’s Customer Information Center at (512) 424-6637 or by email at RAD-LTSS@hhsc.state.tx.us should you have any questions regarding the information in this document.
Free Provider Resource Webinar Series
Free Webinars!!
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 required, click on the “Registration” button below to attend this free webinar and complete pre-survey questions!!
REGISTRATION
or Visit our website: www.twogetherconsulting.com and click on the Free Webinar calendar
Twogether Consulting is happy to have Brittney Russo-COO (Chief Operations Officer) from Core-VA Solutions to discuss her company’s “virtual assistant” services.
Core-VA Solutions provides virtual assistance for any type of long-term healthcare setting, whether it be for a small medical office or therapy office or HCS provider. All of our virtual assistants have a degree in nursing and/or health-related fields.
Core-VA is able to serve clients all over Texas and beyond. Some of the clients these virtual assistants work with are those in HCS, TxHmL, and also other IDD programs. This includes assisting with EVV and TMHP billing. Brittney’s team is able to provide appropriate training to her staff to cater to some of your specific needs, including persons with experience in the HCS/TxHmL programs providing some of that training and the IT solutions which they can learn to use using IT fundamentals here to learn for this. They have “virtual assistants” versed in the use of quite a few electronic health records software such as Taskmaster Pro, Focus, and other EHR and billing software. This is a wonderful resource for HCS/TxHmL providers for sure! This is especially true for some of you, who are brand-new HCS/TxHmL providers. Core-VA serves many different clients in other lines of Long-Term Health Services, but it is so nice to have help from a virtual assistant who understands the world of HCS/TxHmL!
-Core-VA team Solutions is part of our free webinar series for the month of January 2023! Click on their postcard below for more information. Services are available at $10/hr and no contracts.
core va post card
“Core-VA Solutions aims to positively change how your long-term healthcare facility operates with our virtual assistants with degrees in nursing and/or health-related fields. We understand that you may currently waste precious time and money completing tedious tasks such as medical reception, appointment scheduling, insurance authorization, receiving and submitting medical information, and so much more. Instead of hiring expensive employees to complete these much-needed tasks, hire our affordable virtual assistants instead, as we can provide you with the same level of service, at a fraction of the price. All you have to do is let us know how we can help, and our team will find the perfect assistant match for your facility!”
“Support & Empowerment Program For Persons With IDD & Their Caregivers”
Twogether Consulting is happy to have Diana Chavarria from AACOG discuss an amazing program offered via a grant from TCDD (Texas Council For Developmental Disabilities). This is a wonderful resource for IDD providers, Caregivers of persons with IDD and persons with IDD. Dianne is part of our free webinar series for the month of January 2023!
Free Webinar Series Hosted By: Twogether Consulting (1/17/22 from noon-1pm)
Pre-Registration is required, click on the “Registration” button below to attend this free webinar and complete pre-survey questions!!
REGISTRATION
or Visit our website: www.twogetherconsulting.com and click on the Free Webinar calendar
The Program Provides Support & Empowerment For Individuals and Their Caregivers Concerning The Following:
-General Health and Aging
-Aging With Specific Syndromes (i.e. Down Syndrome)
-Nutrition & Physical Fitness
-Financial Wellness
-Benefits and Employment
-Planning For The Future
-Mental Wellness
-Coping With A Diagnosis
-Crisis Management
Some Of Our Previously Recorded Free Webinars of Interest
Here is a link to a short, introductory video about the HRST: https://hrstonline.com/video/index.php?id=410335893
Topic: Health Risk Screening Tool
HRST (Health Risk Screening Tool) is an assessment tool that can identify & detect health risks in vulnerable populations. This tool and other services offered by HRS are based on person-centered practices. Here is a little more information about HRS from their website. The Health Risk Screening Tool (HRST) identifies and tracks health risks in vulnerable populations, making it possible to design a plan tailored to meet the unique health and safety needs of each individual in the least restrictive setting. The instrument can objectively justify resources allocated both financially and in service intensity. Used by Case Managers, supervisors, and direct support professionals. HRS also helps the provider to comply with CMS Rules and assist with Person-Centered planning and continuity of care. It is field-tested, reliable, and user-friendly
“Health Risk Screening, Inc.’s roots began in 1992. Along with training courses, webinars, and materials, HRS is the sole developer, producer, and distributor of the web-based Health Risk Screening Tool (HRST). The HRST is the most widely used and validated health risk screening instrument for people with intellectual and developmental disabilities.
HRS was established on the principles of person-centered practices. Our founder, Karen Green McGowan was a pioneer in the early formative days of the person-centered movement.. Our focus is on developing tools and training for the person-centered support of vulnerable populations. Through the education of government agencies and service providers, we have helped improve people’s lives. Along with training courses, webinars and materials, HRS is the sole developer and distributor of the web-based Health Risk Screening Tool (HRST). The HRST is the most widely used and validated health risk screening instrument for people with disabilities.”
For more information, please contact Hillary Gaytan at: Phone: 727.754.9539 Email: hilary@hrstonline.com
You can also go to their website: www.hrstonline.com
Check out this great page they have devoted to COVID-19 Resources: https://hrstonline.com/covid-19-resources/
Guest presenter:
Patrick Lane (PCT Mentor & Trainer)
From: HRS
Date: Thursday -November 12th, 2020 (Session ended)
Time: 11am-12pm (Central Time)
Cost: Free!!!
Where: See recorded link below:
https://attendee.gotowebinar.com/recording/1049673375643527182
Topic: Person-Centered Services
Patrick will be talking about some of the Person-Centered Services offered at HRS including software that helps the provider develop Person-Centered Descriptions. These can be used as a resource for making annual plans Person-Centered by using these same person-centered skills practiced in PCT sessions.
“Person-Centered Planning Training is designed to help you approach support from a more holistic angle, with person-centered practices that respect the autonomy of those with intellectual and developmental disabilities while providing them with the highest possible level of care.”
Improve The Quality of Life
- Balancing personal choice with personal responsibility by establishing and maintaining things that are important to the person with things that are important for the person
- Being integrated in one’s community so that the person is known and respected for her or his contributions.
- Being respectfully communicated with as a person, using language consistent with being a typical adult as opposed to using clinical or system language
- Receiving support that is consistent so that new staff and others know and respect the person’s values and choices, as well as how others can help the person.
- Being matches with staff, housemates, or others that the person making life more enjoyable.
You can contact Patrick at: patrick@hrstonline.com For more info about HRS PCT services, please see the following link: https://hrstonline.com/person-centered-services/
Guest presenter:
Steve Cardie
From: Abundant Health
Date: Tuesday -November 17th, 2020 (Session ended)
Time: Noon-12:45 pm (Central Time)
Cost: Free!!!
Where: See link to the recorded session below:
https://attendee.gotowebinar.com/recording/5931551182568587528
Topic: Cellular Blood Pressure Monitoring System (Free To Medicare Patients!)
“Our new Cellular Blood Pressure Monitor System connects automatically to cell towers and transmits your patient’s information directly to your practice. This device makes it simple for seniors who tend to be more technology challenged to utilize Medicare’s RPM program without the difficulty of connecting to cell phones or the internet. No passwords, no Bluetooth, no internet connections required.
The rapid advance of medical device design plus an enormous upgrade in telecommunications makes Remote Patient Monitoring (RPM) suddenly possible for virtually everyone. Anywhere. In November 2018 CMS officially approved three new billing codes for Remote Patient Monitoring (RPM). The telehealth industry experts agree that this is the biggest financial incentive to date in the history of digital medicine.”
Register for the webinar at https://attendee.gotowebinar.com/register/3642654945259750160
Letter From Twogether Consulting To Providers-January 2023 Update
|
Starting Jan. 2023: New Application Process for the HCS and TXHML Waivers Contractors
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.
To apply, you must complete the Provider Applicant Training (PAT). The PAT is now available on the HHS Learning Portal. Do not take the PAT if you aren’t applying for an HCS and TxHmL waiver contract.
- You must get a score of 85% or higher to pass the exam. Lower scores will not be accepted.
- After completing the PAT, you can apply using Form 5873 Waiver and Community-based Programs and Services. Your PAT exam certificate must be included with your application packet. Do not apply without a PAT exam certificate showing your passing score.
Mail Your Application to the Waiver Program Enrollment Team
Send to this address:
HHSC
Contract Administration and Provider Monitoring
Mail Code W-359 P.O. Box 149030
Austin, TX 78714-9030
Applicants can also submit applications by email: IDDWaiverContractEnrollment@hhsc.state.tx.us or fax: 512-206-3916.
More resources can be found on the HHSC website, including guidance on how to apply and manage your contracts. If you have any questions about the application process, please email us.
Expedited PPE Delivery for Long-Term Care Providers
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 Assistance and Support Services, Deaf Blind with Multiple Disabilities, and Medically Dependent Children Program
- Texas Home Living
- Prescribed Pediatric Extended Care Centers
- Hospice
- Day Activity Health Services
Long-term care providers who have a current need for these specific resources can submit requests by visiting star.tdem.texas.gov and selecting the “Expedited PPE” button. The generic passcode for the inventory listed above is: 112518.
Items are available on a first-come, first-served basis. This system is only to be used on a one-time basis for expedited PPE only. If a provider needs these resources, please include the amount needed in your request.
HCS & ICF Emergency & Disaster Preparation Updates
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 emergency preparedness policies and procedures.
Facilities with generators should perform any maintenance or needed testing while the weather is mild. This will ensure the equipment functions in case of extreme cold or power loss.
It is important to review building integrity and identify any areas that may need repair, reinforcement or weatherproofing. Multi-story buildings should review any other needed measures should evacuation be required and have a plan in place for how to move residents around or out of the building if there is a loss of power.
Preparing for disaster is the most important step in protecting our most fragile Texans and reducing the risk for loss of life.
May 26th, 2022
Guidance related to Emergency Preparedness- Exercise Exemption based on A Facility’s Activation of their Emergency Plan *** Revised to provide additional guidance and clarifications due to the ongoing COVID-19 public health emergency (PHE) REVISED 05.26.2022 ***
Memorandum Summary
• Emergency Preparedness Training and Testing Program Exemption -CMS regulations for Emergency Preparedness (EP) require facilities to conduct exercises to test the facility’s EP plan to ensure that it works and that staff are trained appropriately about their roles and the facility’s processes. During or after an actual emergency, the regulations allow for a one-year exemption from the requirement that the facility perform testing exercises.
• This worksheet presents guidance for surveyors, as well as providers and suppliers, with assessing a facility’s compliance with the EP requirements, in light of many of the response activities associated with the COVID-19 Public Health Emergency (PHE).
• As the PHE continues, many facilities continue to operate under their respective activated emergency plans. Therefore, CMS is providing additional guidance related to the exercise requirements (full-scale/functional drills and exercises) for inpatient and outpatient providers/suppliers.
• This exemption only applies to the next required full-scale exercise (not the exercise of choice), based on the facility’s 12-month exercise cycle. The cycle is determined by the facility (e.g. calendar, fiscal or another 12-month timeframe).
***All revisions are in red on this letter from CMS, click the link below for the complete document.
September 13th, 2021
Very Important Updates on Emergency & Disaster Preparedness During the Pandemic
Resources Listed Are From CMS & HHSC
See Info For ICF Facilities Below
Life Safety: Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM)
Emergency Preparedness Participant Workbook
Interim Guidance for General Population Disaster Shelters During the COVID-19 Pandemic
Screening Tool For COVID-19 During Pandemic For Arrival At General Population Shelters
Out-of-Hospital Do-Not-Resuscitate Order (From DSHS)
Out-of-Hospital Do-Not-Resuscitate Order
Out-of-Hospital Do-Not-Resuscitate (OOH DNR) order.
Both the English and Spanish versions can be downloaded on the EMS and Trauma Systems website, along with “Frequently Asked Questions About OOH DNR,” also in both languages.
For questions related to OOH DNR orders, email EMSInfo@dshs.texas.gov.
“Moving Forward Together” 2022 Conference for ICF Surveyors and Providers- Dec. 1st, 2022
“Moving Forward Together” 2022 Conference for ICF Surveyors and Providers- Dec. 1st, 2022
Dec. 1 ICF Conference Recordings Available
The “Moving Forward Together” Intermediate Care Facilities Conference session recordings from Dec. 1 are available for viewing. Note that a certificate of completion will be generated upon completion, but no professional CE awards are available.
Listen to the ICF session recordings.
Email questions to LTCR Joint Training.
ICF COVID-19 Response & COVID-19 FAQs Retired By HHSC-Dec. 13th, 2022
December 18th, 2022
HHSC Long-term Care (LTC) Regulation has retired the COVID-19 Response for ICF for Individuals with an Intellectual Disability or Related Conditions Response Plan and the ICF Frequently Asked Questions documents, effective Dec. 13, 2022.
Facilities can obtain guidance along with resources for infection prevention, control measures, and Personal Protective Equipment (PPE) through the Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF) and Infection Control Basics & Personal Protective Equipment for Essential Caregivers (PDF) documents published by HHSC.
These resources can also be found on the ICF Provider Portal page.
Program providers may reach out to LTCR Policy with questions at LTCRPolicy@hhs.texas.gov.
ICF/IID Updates
December 15th, 2022
ICF Resources
These resources can also be found on the ICF Provider Portal page.
September 25th, 2022
HHSC Publishes Updated Guidance on the Amelioration of Administrative Penalties for ALF, ICF/IID, and NF Providers
HHSC Long-term Care Regulation has published Provider Letter 2022-24 – Amelioration of Administrative Penalties (replaces PL 2013-18).
The letter provides guidelines to assisted living facilities,
intermediate care facilities for individuals with an intellectual
disability or related conditions, and nursing facilities about
the amelioration of administrative penalties assessed for state licensure
violations.
Read the provider letter details.
June 12th, 2022
ICF COVID-19 Vaccination Reporting Emergency Rules Expired June 6!!
Emergency rules for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions that require COVID-19 vaccination reporting expired June 6.
This means that effective June 7, ICFs no longer have to report COVID-19 vaccination data for staff and individuals to HHSC.
The following rules expired June 6:
- 26 TAC §551.48 – ICF/IID Provider COVID-19 Vaccination Data Reporting Requirement.
Here is a copy of the previous rule that expired:
551.48.ICF/IID Provider COVID-19 Vaccination Data Reporting Requirement.
(a) An intermediate care facility administrator and one additional designee must enroll in an emergency communication system in accordance with instructions from Texas Health and Human Services Commission (HHSC).
(b) An intermediate care facility must respond to requests for information received through the emergency communication system in the format established by HHSC.
(c) Within 24 hours of becoming aware of a staff or resident’s COVID-19 vaccination, an intermediate care facility must accurately report COVID-19 vaccination data for staff and individuals in the format established by HHSC.
(d) Subsection (c) of this section does not apply to state supported living centers.
The agency certifies that legal counsel has reviewed the emergency adoption and found it to be within the state agency’s legal authority to adopt.
Filed with the Office of the Secretary of State on August 10, 2021.
Email questions to LTCR Policy.
April 29th, 2022
ICF Visitation Rules Update
An alert went out to remind providers that all visitation must be allowed. Essential caregiver and end-of-life visits must be allowed for all individuals with any COVID-19 status. A facility may be cited if visitation is not allowed.
Review ICF/IID visitation rules from April 4th, 2022, for additional information.
April 10th, 2022
COVID-19 ICF Mitigation, Response Rule Revised Effective April 6
HHSC Long-term Care Regulation has published a revised Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Mitigation and Response Emergency Rule. It is effective April 6, 2022.
The revised rule:
- Removes the requirements to have plans for obtaining and maintaining a two-week supply of full PPE.
- Clarifies that a facility does not have to provide the name of the person who tested positive for COVID-19 when reporting to CII.
April 10th, 2022
HHSC Publishes Description of Key Changes to 26 TAC 551, ICF/IID (PL 2022-07)
HHSC has published Provider Letter 2022-07, Description of Key Changes to 26 TAC 551, Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions, for ICF/IID providers. This letter describes the key changes to Title 26 of the Texas Administrative Code, Chapter 551, that were effective on Feb. 24.
Throughout the rule, HHSC updated citations, agency names, and terminology; corrected minor grammatical and punctuation errors; and revised sentence structures to make the chapter easier to read. In addition, the following items are addressed in this letter:
– New Requirements for Infection Prevention and Control Policies and Procedures
-HHSC included a state rule that refers to each Centers for Medicare & Medicaid Services (CMS) Condition of Participation (CoP). Additions to 26 TAC 551 include • Governing Body • Client Protections • Facility Staffing • Active Treatment • Client Behavior and Facility Practices • Health Care Services • Physical Environment • Emergency Preparedness • Dietetic Services.
– transition from paper applications to the use of the online licensure portal, called the Texas Unified Licensure Information Portal (TULIP) (Disclose information when applying for “relocation” and application information must be submitted through portal in “TULIP” system)
-Now require evaluation of the emergency preparedness and response plan at least every two years, instead of annually.
-ANE & Incident definitions
-Administrative penalties for each visit are limited to the cap amount, regardless of the number or duration of violations as of Sept. 1st, 2021
****If you have any questions about this letter, please contact the Policy and Rules Section by email at LTCRPolicy@hhs.texas.gov or call (512) 438-3161
April 6th, 2022
COVID Screening in ICF’s
ICF COVID-19 Mitigation and Provider Response emergency rules require an intermediate care facility must screen individuals according to HHSC guidance
.ICFs must screen individuals:
•upon admission or readmission to the facility; and
•at least once a day.
ICFs must screen each employee or contractor for the following criteria (listed below) before entering the facility at the start of their shift.
•Staff screenings must be documented in a log kept at the facility entrance and must include the name of each person screened, the date and time of the evaluation, and the results of the evaluation.
**Staff who meet any of the criteria must not be permitted to enter the facility.
As per ICF/IID Expansion of Reopening Visitation Emergency rules, ICFs are required to screen all visitors for signs or symptoms of COVID-19.
*Visitor screenings must be documented in a log kept at the entrance to the facility, which must include the name of each person screened, the date and time of the screening, and the results of the screening. The visitor screening log may contain protected health information and must be protected in accordance with applicable state and federal law .
*A visitor may not participate in a visit if the visitor has signs and symptoms of COVID-19 or active COVID-19 infection.
Screening Criteria:
•fever, defined as a temperature of 100.4 Fahrenheit and above, or
signs or symptoms of a respiratory infection, such as cough, shortness of breath, or sore throat;
•other signs or symptoms of COVID-19, including
-chills,
-new or worsening cough,
-shortness of breath or difficulty breathing,
-fatigue,
-muscle or body aches,
-headache,
-new loss of taste or smell,
-sore throat,
-congestion or runny nose,
-nausea or vomiting,
-or diarrhea;
•any other signs and symptoms as outlined by the CDC in Symptoms or Coronavirus at cdc.gov;
•contact in the last 14 days with someone who has a confirmed diagnosis of COVID-19, is under investigation for COVID-19, or is ill with a respiratory illness, regardless of whether the person is fully vaccinated, unless the person is entering the facility to provide critical assistance; or
•testing positive for COVID-19 in the last 10 days.
April 6th, 2022
Reporting Confirmed Case of COVID-19 in ICF/IID
A facility must notify the Texas Health and Human Services Commission (HHSC) Complaint and Incident Intake of COVID-19 activity as described below.
(1) A facility must notify HHSC of the first confirmed case of COVID-19 in staff or individuals, and the first confirmed case of COVID-19 after a facility has been without cases for 14 days or more, at HHSC Complaint and Incident Intake (CII) through TULIP, or by calling 1-800-458-9858, within 24 hours of the positive confirmation.
(2) A facility must submit a Form 3613-A Provider Investigation Report, minus the name of the person who tested positive for COVID-19, to HHSC Complaint and Incident Intake, through TULIP, by email at ciiprovider@hhs.texas.gov, or by fax at 877-438-5827, within five working days from the day a confirmed case is reported to CII.
April 6th, 2022
COVID-19 Mitigation and Response Emergency Rule Updated
HHSC Long-term Care Regulation has published a revised Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Mitigation and Response Emergency Rule.
It became effective April 6, 2022.
The revised rule:
•Points to guidance from the Texas Department of State Health Services and HHSC rather than the CDC.
•Removes the requirements to have plans for obtaining and maintaining a two-week supply of full PPE.
•Removes the requirement to have spaces to don and doff PPE
•Clarifies that a facility does not have to provide the name of the person who tested positive for COVID-19 when reporting to CII.
February 27th, 2022
HHSC Adopts Revised ICF/IID Rules – Effective Feb. 24th, 2022
HHSC Long-term Care Regulation has adopted updates to the Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IID) or Related Conditions program rules. The revised rules are in the Texas Administrative Code Title 26, Chapter 551. They are effective Feb. 24, 2022.
Key changes to the rule are to:
- Implement House Bill 1848 from the 86th Legislature, Regular Session, 2019 which requires new infection control policies and procedures in long-term living facilities.
- Implement House Bill 3720 from the 87th Legislature, Regular Session, 2021 which limits the total amount of an administrative penalty assessed against an ICF/IID.
- Reintegrate the conditions of participation from the Code of Federal Regulations.
- Corrects legacy agency terms, update rule citations, and edit for clarity and consistency.
COVID-19 ICF/IID Webinar Recording from Feb. 14 Available
A recording of the Feb. 14 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Q&A with HHSC Long-term Care Regulation and DSHS is available for those who could not attend.
There have been changes made to the PowerPoint based on the information provided by DSHS during the webinar.
Listen to the webinar recording.
Email LTCR Policy for the transcript.
February. 20th, 2022
Mar. 07 ICF COVID-19 Webinar with HHSC LTCR
Long-term Care Regulation and the Department of State Health Services will provide the latest information on the COVID-19 pandemic and take live questions from participants in this intermediate care facilities provider webinar.
Provider attendance is critical to staying current with COVID-19 requirements and guidance. ICF/IID providers are strongly encouraged to attend all COVID-19 webinars with LTCR and DSHS.
Those using Internet Explorer may have difficulties registering for the webinar. If so, try using another browser, such as Google Chrome or Microsoft Edge.
March 7, 2022
11 a.m.–12 p.m.
Register for the COVID-19 Webinar.
February 13th, 2022
HHSC is not currently assessing compliance with CMS’s Omnibus COVID-19 Health Care Staff Vaccination rules, published in the Federal Register on November 5, 2021.
ICF COVID-19 Vaccination Data Reporting and Emergency Communication System – Feb 7
HHSC Long-term Care Regulation has published a revised ICF/IID Provider COVID-19 Vaccination Data Reporting Rule (PDF). It became effective February 7, 2022 and includes Emergency Communication System Enrollment for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions providers.
The rule requires ICF/IIDs to:
- Report COVID-19 vaccine data within 24 hours
- Enroll in an emergency communication system
January 7th, 2022
ICF COVID-19 Response Plan and FAQ Updated – Jan. 7
Document Version Date Change Comments
Version 3.5 1/5/2022 Changes to pages 6, 31, 38, 39, 40, 51, 72 71, and Changes made to reflect the most updated CDC guidance.
Version 3.4 12/07/2021 Changes to pages 15, 16, 25, 26, 31, 35 Edited to include revised ICF COVID-19 Provider Response Mitigation Rules for ICFs/IID
For changes made previous to 12/07/2021, please read the Table of Changes starting with page 7 of 19 of the Response Plan.
Update your Infection Control Policies and other related policies accordingly.
HHSC has revised the ICF COVID-19 Response Plan and Frequently Asked Questions document in response to the most recent CDC guidance.
November 21st, 2021
HHSC Publishes PL 2021-38 Medicaid Bed Reallocation
HHSC published Provider Letter 2021-38 Medicaid Bed Reallocation which explains the process to request reallocated ICF/IID Medicaid beds from HHSC. This letter replaces Provider Letter 2019-21.
November 4th, 2021
Updated ICF/IID COVID-19 FAQ and COVID-19 Response Plan Revised
HHSC has revised the Frequently Asked Questions for ICF/IIDs about COVID-19 (PDF) and the ICF/IID COVID-19 Response Plan (PDF) in response to the revised COVID-19 Expansion of Reopening Visitation for ICF Providers rules.
October 24th, 2021
New PL 2021-21 COVID-19 – Expansion of Reopening Visitation for ICF Providers
Super important!!!!
HHSC has published Provider Letter 2021-21, COVID-19 Response – Expansion of Reopening Visitation (PDF) for ICF/IID providers. This letter replaces Provider Letter 2021-10. This letter describes the criteria for expanded visitation as well as address changes in response to Executive Order No. GA-38(link is external) and updated CDC guidance.
Updated COVID-19 Expansion of Reopening Visitation Emergency Rules for ICF Providers
HHSC Long-term Care Regulation has published revised COVID-19 Expansion of Reopening Visitation Emergency Rules for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) or Related Conditions (PDF). The rules address changes in response to Executive Order No. GA-38 (PDF)(link is external) and updated CDC guidance.The rules became effective on October 20, 2021.
September 15th, 2021
HHSC Publishes Amended Statutory Cap Regarding Administrative Penalties for ICFs: (PL 21-34)
HHSC published Provider Letter 21-34 Amended Statutory Cap Regarding Administrative Penalties for Intermediate Care Facilities. PL 21-34 notifies providers of changes to how HHSC determines and imposes administrative penalties based on changes made by House Bill 3720 (87th Legislature, Regular Session, 2021).
September 5th, 2021
Guidance for Providers Regarding Entry into LTC Facilities (PL 2021-33)
HHSC Long-term Care Regulation has published Provider Letter 2021-33, Authority to Enter Long-term Care Facilities (PDF), for ALF, HCS, ICF/IID and NF providers. This letter reminds providers that they must allow persons providing critical assistance and providers of essential services to enter the facility if they pass the facility’s COVID-19 screening.
September 5th, 2021
ICF/IID Leave During COVID-19 Rule Reinstated
HHSC has published IL 2021-42 ICF/IID Services During COVID-19 (PDF), which replaces IL 2020-43.
A resident must be discharged from the Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions, with or without a contract to hold the resident’s placement in accordance with 26 TAC Section 261.227(j), if the resident is absent from the ICF/IID for one full day or more and the absence is not during leave described in 26 TAC Section 261.226.
August 1st, 2021
HHSC Publishes Updated COVID-19 Response Plan and Frequently Asked Questions for ICF Providers
HHSC Long-term Care Regulation updated the ICF COVID-19 Response Plan and FAQ document on July 29, 2021.
Read the updated ICF COVID-19 Response Plan (PDF).
Read the updated ICF FAQs (PDF).
March 24th, 2021
HHSC Adopts New Expansion of Reopening Visitation Emergency Rules for ICF Providers!!!
HHSC has adopted new Expansion of Reopening Visitation (PDF) emergency rules that establish criteria for expanded indoor and outdoor visitation as well as essential caregiver visits. These rules are effective March 24, 2021.
HHSC Publishes COVID-19 Response – Expansion of Reopening Visitation for ICF Providers (PL 2021-10)
HHSC has published Provider Letter 2021-10, COVID-19 Response – Expansion of Reopening Visitation (PDF) for ICF/IID providers. This letter replaces Provider Letter 2020-43. This letter describes the criteria for expanded indoor and outdoor visitation as well as essential caregiver visits.
March 22nd, 2021
ICF COVID-19 March 22 Webinar Recording Available
A recording of the March 22, 2021, ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.
Listen to the COVID-19 Q&A recording.
March 11th, 2021
Recording of ICF COVID-19 March 8 Provider Webinar Available
A recording of the March 8, 2021 ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.
Listen to the COVID-19 Q&A recording.
February 8th, 2021
Draft ICF/IID Rule Changes
- Draft ICF/IID Rule Changes- See link: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:cf5ea154-04b4-4c75-8aec-7e230c3cfda0
- High Level Summary of Proposed Changes See link: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:2aa689d6-3018-4ab9-8d75-04578f4c922d
February 7th, 2021
Feb. 8- ICF/IID Provider Bed Hold Payments Webinar &
Reminder to Provide Letter to Families
IL 2020-43, ICF/IID Services During COVID-19 directed program providers to give a copy of the letter attached to that IL to each resident who was:
- Absent from an ICF/IID
- Not on leave
- Was not discharged from the ICF/IID
If you have not provided the letter to residents who meet that criteria, do so immediately. It was to be complete by Oct. 5, 2020. You must assist residents in deciding to do only one of the following:
- Return to the facility.
- Continue to be absent from the facility, be discharged, but enter into an agreement with the ICF/IID to hold your place at the facility.
- Continue to be absent from the facility and be discharged.
HHSC Medicaid and CHIP Services will issue instructions to providers about entering COVID-19 therapeutic leave for days a resident was away from an ICF/IID to reduce the risk of COVID-19 transmission. Register for the following webinar to review the emergency rules authorizing this leave and the instructions for entering it.
ICF/IID Provider Bed Hold Payments Webinar
Friday, Feb. 5
9:30-11 a.m.
Register for the Bed Hold Payment Webinar.
The emergency rule authorizing payment for COVID-19 therapeutic leave (PDF) is effective Jan. 29, 2021.
January 19th, 2021
HHSC Updates the ICF COVID-19 Response Plan and FAQ Document
Please be sure to update your infection control and other related policies based on the updated Response Plan!!!
Let us know if we can help. We will be working on some of these addendums in the next few weeks.
HHSC Long-term Care Regulation updated the ICF COVID-19 Response Plan and FAQ document on Jan. 12, 2021.
Read the updated ICF COVID-19 Response Plan (PDF).
Read the updated ICF FAQs (PDF).
Jan. 25 ICF Provider COVID-19 Webinar with HHSC LTC Regulation
Long-term Care Regulation and the Department of State Health Services provide the latest information on the COVID-19 pandemic and take live questions from participants in this ICF provider webinar. Provider attendance is critical to staying current with COVID-19 requirements and guidance.
ICF/IID providers are strongly encouraged to attend this and all biweekly COVID-19 webinars with LTCR and DSHS.
Those using Internet Explorer may have difficulties registering for the webinar. Please try another browser such as Google Chrome or Microsoft Edge.
ICF Provider Webinar
Jan. 25, 2021
11 a.m. – 12:30 p.m.
Register for the COVID-19 Webinar.
Recording of ICF COVID-19 Jan. 11 Provider Webinar Available
A recording of the January 11, 2021 ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.
Listen to the COVID-19 Q&A recording.
January 10th, 2021
Informal Comments on Draft Rules for ICF/IID or Related Conditions
HHSC is accepting informal comments from stakeholders on the following draft rules, which are now posted on the HHS Rulemaking page. The comment period ends Jan. 19, 2021.
This project implements two bills from the 86th Legislature, Regular Session, 2019. House Bill (H.B.) 1848 contains required elements for infection prevention and control. H.B. 3803 limits the daily amount of an administrative penalty assessed against an ICF/IID. The project will also update rule references and agency names, amend rules to align with Centers for Medicare & Medicaid Services conditions of participation in the ICF/IID program, and edit the rules for clarity and consistency.
HHSC Publishes Revised Reporting Guidance for Long-Term Care Providers
(PL 20-37)
HHSC has published a revised version of Provider Letter 20-37, Reporting Guidance for Long-Term Care Providers (PDF). The revision includes information for ALF and ICF providers offering point-of-care testing for COVID-19 and clarifies reporting requirements for NF providers.
November 22nd, 2020
November 30 ICF Provider COVID-19 Webinar with HHSC LTC Regulation
LTCR and DSHS provide the latest information on the COVID-19 pandemic and take live questions from participants in this ICF provider webinar. Provider attendance is critical to staying current with COVID-19 requirements and guidance.
ICF/IID providers are strongly encouraged to attend this and all biweekly COVID-19 webinars with HHSC Long-term Care Regulation and the Department of State Health Services.
Those using Internet Explorer may have difficulties registering for the webinar. Please try another browser such as Google Chrome or Microsoft Edge.
ICF Provider Webinar
November 30, 2020
11 a.m. – 12:30 p.m.
Register for the COVID-19 webinar.
Recording of November 16 ICF COVID-19 Q&A Provider Webinar Available
A recording of the November 16, 2020 ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.
View the COVID-19 Q&A recording.
10/16/20
Important Information!
LTCR FORM 2195: Expansion of Reopening Visitation Status Attestation and Letter PL 20-43 (for ICF Only)
Note: to receive an approved general visitation designation, a small ICF/IID that cannot provide separate areas, units, wings, halls, or buildings for individuals who are COVID-19 positive, COVID-19 negative or unknown COVID-19 status, based on the status of the entire facility, must:
- have no facility-acquired COVID-19 cases in individuals for at least 14 consecutive days; and
- have no COVID-19 cases in staff.
An ICF/IID must provide instructional signage throughout the facility and proper visitor education regarding
- signs and symptoms of COVID-19;
- infection control precautions; and
- other applicable facility practices (e.g., the use of facemasks or other appropriate PPE, specified entries and exits, routes to designated visitation areas, and hand hygiene).
An ICF/IID that does not meet the criteria for a visitation designation must permit closed window visits and end-of-life visits for individuals regardless of their COVID-19 status, as well as essential caregiver visits for individuals with COVID-19 negative or unknown COVID-19 status.
Such an ICF/IID must also develop and implement a plan to meet the visitation criteria and submit the plan to the regional director in the Long-term Care Regulation (LTCR) region where the ICF/IID is located within five days of submitting the new 2195 Expansion of Reopening Visitation Status Attestation Form,
or
within five days of receiving notification from HHSC that the ICF/IID was not approved for general visitation designation.
LTCR Form 2195
Each ICF/IID must submit LTCR Form 2195 to the Regional Director in the LTCR region where the facility is located and must provide information about whether the ICF/IID meets or does not meet the criteria for expanded general visitation.
Each ICF/IID must submit a completed form 2195 to the Regional Director no later than October 31, 2020.
An ICF/IID that does not meet the visitation designation criteria must attest that it:
- is permitting closed window visits, end of life visits, and essential caregiver visits;
- will develop and implement a plan to meet the visitation designation criteria as defined in 26 TAC §551.47; and
- has included the plan with the form or will submit the plan within five business days of submitting the form.
To seek a designation for general visitation, an ICF/IID must complete LTCR Form 2195, Expansion of Reopening Visitation Status Attestation, to notify LTCR that the ICF/IID seeks a designation as a visitation facility.
The form must be emailed to the LTCR regional director in the LTCR region where the facility is located. Any applicable pictures and facility maps must also be included with LTCR Form 2195.
The LTCR regional director or designee will review the form within three working days of submission and notify the ICF/IID whether it has received been approved for a visitation designation.
An ICF/IID with previous approval for visitation does not have to submit LTCR Form 2195 or other documentation unless the previous visitation approval has been withdrawn, rescinded, or canceled, or was for only indoor or outdoor visitation instead of both indoor and outdoor visitation.
If approved, the ICF/IID must allow outdoor visits, indoor plexiglass visits, open window visits, and vehicle parades in accordance with the applicable emergency rule. HHSC LTCR can conduct an on-site visit to confirm an ICF/IID’s compliance with the requirements. If HHSC determines that the ICF/IID does not meet the requirements for the designation as a visitation facility, the ICF/IID must immediately stop all visitation except a closed window visit, end-of-life visit, and visits by persons providing critical assistance, including designated essential caregivers.
If, at any time after a visitation designation is approved by HHSC, the ICF/IID experiences an outbreak of COVID-19, the ICF/IID must notify the Regional Director in the LTCR Region where it is located that the ICF/IID no longer meets visitation criteria, and the ICF/IID must immediately stop all visitation, except a closed window visit, end-of-life visit, or visits by persons providing critical assistance, including essential caregivers.
The ICF/IID can submit a new request for designation when it meets all visitation criteria.
Under Section 37.10 of the Texas Penal Code, a person commits a criminal offense if he or she makes a false entry in a governmental record; makes, presents, or uses any record or document with knowledge of its falsity and intent that it be taken as a genuine governmental record; or makes, presents, or uses a governmental record with knowledge of its falsity. In addition, making a false statement on the attestation form can result in the imposition of an administrative penalty as described in Texas Health and Safety Code, Chapter 252, section 252.065(a)
Contact Information for Submitting LTCR Form 2195 to the LTCR Regional Director: https://hhs.texas.gov/about-hhs/find-us/long-term-care-regulatory-regional-contact-numbers
If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at PolicyRulesTraining@hhsc.state.tx.us or call (512) 438-3161.
10/05/20
Deadline for Decision To Return to Facility/Payment to Hold Bed/Discharge Option
Information Letter No. 20-43 ICF/IID Services During COVID-19
10/03/20
Quick TIPS on New Changes for Expansion of Facility Visitation Rules & Other Policies Concerning COVID-19
Essential Caregiver Visits and Salon Services Visitor (Visitor types above and beyond normal designated visiting facility type)
Essential Caregivers are allowed even if the facility does not have designated visitation. They must be at least 18 years of age. Can be family, friend, guardian.
- 1.They must wear a facemask. 2. They must have evidence of negative COVID-19 test in the past 14 days and must be screened by facility staff prior to the visit. (Pay attention to the new additional symptoms and discontinuation of asking about international travel). 3. There is a 2- hr limit unless the facility allows a longer period of time. 4.They can have physical contact with their individual (and only their individual) 5.They must be limited to access to their person. 6.An assigned person must escort them to and from the location they are going to meet with the individual- room, outside… 7. The facility must approve the face mask they are going to wear or provide an appropriate mask. 8.If they do not have an appropriate face mask or the facility can’t provide one, they will need to reschedule the visit. 9. The facility must create an identifying badge for the essential caregiver or any salon service visitors. 10. The facility must have attestation stating the essential caregiver has visited and when they left (include time arrived, when they left, who they visited). 11. Essential caregivers must be trained on PPE and how to wear PPE, handwashing, and other infection control practices and there must be proof of this training that the facility maintains. 12..The individual must be COVID-19 negative to have an Essential caregiver visit or Salon Service Visitor.
- ***(If client status is unknown, the essential visitor would have to wear a face mask (not N-95, save that for your staff who need to work with COVID-19 + individuals), gown, gloves, goggles or face shield, so the facility might need to provide these other items)
Phase I Visitation Rules, no longer in effect!
Expanded Visitation Rules now in effect: The facility must apply with form 2194 for the Designated Visitation Facility, do not require all these same requirements an essential visitor (or Salon Service Visitors)- Designated visits include: open window visits, closed window visits, parade visits (open window or closed) outside visits, (and in plexiglass separate areas). Must use physical distance, visitor screening, individual will wear face mask or face covering if tolerated and the same for the visitor -they must wear a face mask or face covering. Provider Letter 20-38 has the link with form 2194 at the end of it. We encourage you to email the form. Most staff at HHSC are not in the office Visitation Designation department has 3 days to approve or deny the 2194 form request. Only the administrator or director can fill out form 2194!!
Previous Level 1 Attestation Approval: If you previously submitted the 2192 and received approval, you do not need to request a new one with form 2194, if your status is the same. If you want to change the visitation type, then you will need a new form. ( i.e. you did not want plexiglass partition previously and now you do.)
Small facilities must request visitation designation for the whole facility (unless you have a way to separate all cohort areas completely.) Do not fill out section #3. That is only for NF’s.
The provider must develop and must enforce policies and procedures including testing strategies for Essential Visitors, in addition to the testing that must occur at least 14 days prior to 1st visit and all other polices related, such as essential visitor requirements discussed above. Remember your testing strategies are required to provide expectations for the essential visitor for how often they will be required to test and when, for any visits they are making, after the initial “essential caregiver visit”.
For vehicle parades, the individual needs to remain 10 ft or more from the vehicle for safety.
Plexiglass booths on the inside must be approved by a life safety person for your region. Send in pictures. Does have to be a plexiglass barrier, does not have to be 2 and 3 sided.
**Closed window and End of Life visits are the only visits an individual may have if they are COVID-19 + (positive)
Remember staff should be assigned to an appropriate cohort (COVID-19 +, COVID-19 Negative or Unknown) then they should stay with that Cohort. In addition, there should be a policy at the facility for limiting the sharing of staff. If you need help with your policy concerning “COHORTS” and ” Mitigation of COVID-19 by Limiting Sharing of Staff”, please contact us. I do have some policies you can purchase if needed. Please contact me at: info@twogetherconsulting.com
FAQ’s (June 2020)
Answer: Regulations regarding ICF/IID discharge have not been waived. A discharge, even on a temporary emergency basis, requires that key developmental, behavioral, social, health and nutritional information be shared with the accepting facility in the community or non-facility provider. CMS is aware that staffing shortages and/or client surges due to the PHE create a high demand on available staff time that makes it difficult to complete a full discharge summary for each client. Each ICF will need to evaluate what amount and detail of documentation is necessary to ensure that critical health information is shared with the accepting facility or other provider. When available and if appropriate, the Interdisciplinary Team (IDT) should maximize the use of telehealth for the completion of a client’s discharge plan during the PHE.
Answer: Yes. CMS has temporarily waived certain regulatory requirements providing flexibilities to assist RHCs and FQHCs in furnishing services during the COVID-19 PHE. This includes temporarily modifying the following:(a)50% mid-level staffing requirement for RHCs;(b)Physician supervision requirement for nurse practitioners (NPs), to the extent permitted by State law; and(c)Location requirements for existing RHCs and FQHC to allow additions of temporary service locations.Please see https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf for additional waiver information. Additional flexibilities, including guidance for RHCs and FQHCs furnishing telehealth services during the PHE, are also described in this CMS MLN Article: https://www.cms.gov/files/document/se20016.pdf
Answer: Yes. During the COVID-19 PHE, CMS is allowing currently approved RHCs/FQHCs to provide patient care services in temporary expansion sites to help address the urgent need for supplementary care. These temporary sites are not restricted to the rural/shortage area location requirements. Each location is obligated to follow RHC/FQHC regulations to the extent not waived. Therefore, the RHC/FQHC may provide services provided at a temporary location under the CMS Certification Number (CCN) for the permanent location. The RHC/FQHC is expected to be operating in a manner not inconsistent with its state’s emergency preparedness plan. Note: FQHCs must also have an updated Health Resource and Service Administration (HRSA) Notice of Award, expanding the scope of service to include the temporary location(s) to support response to the COVID-19 PHE.
My RHC participates in Medicare through one of the two CMS-approved RHC Accreditation Organizations (AOs). Do waivers of CMS regulations apply to CMS-approved accrediting programs? Do I need to notify the AO of my desire to temporarily add a service location during the COVID-19 PHE?
Answer: To assist RHCs and FQHCs in furnishing service during the COVID-19 PHE, CMS has provided additional flexibilities related to billing for services. These temporary flexibilities currently include Expansion of Virtual Communication Services for RHCs and FQHCs to include online digital evaluation and management services using patient portals, and Revision of Home Health Agency Shortage Area Requirement for Visiting Nursing Services Furnished by RHCs and FQHCs. Please see the Medicare FFS Billing FAQ document available at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. Please see Section II.L of the Interim Final Rule with Comment Period, “Medicare and Expanded Flexibilities for Rural Health Clinics (RHCs) Medicaid Programs; Policy and Federally Qualified Health Centers (FQHCs) During Regulatory Revisions in Response to the COVID-–19 Public Health Emergency (PHE)”(85 FR 19230, 19253), available at https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public, for more information on regulatory changes for RHCs and FQHCs.
Webinar info: How to prevent infectious diseases and the spread of infectious diseases in ICF-Specifically COVID-19 (May 27th, 2020)
See the following pdf link from HHSC
https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/icfiid-covid-updates-qa-webinar-may-27-2020.pdf
Survey Operations Resume as of June 15th, 2020
Providers Must Log Residents’ Leave
All community-based ICF/IID program providers must submit an absence request in the TMHP ICF/IID Online Portal for a resident away from the facility for one or more full days. See the TMHP ICF/IID Online Portal User Guide (PDF) starting on page 52 for more information. The program provider must submit a return request within three days after a resident returns to the facility. See page 58 of the Online Portal User Guide for an explanation.
Please ensure that information entered in the portal for absences is current. HHSC uses the information to determine how many residents are absent from their facilities and the length of those absences.
PolicyRulesTraining@hhsc.state.tx.us or call (512) 438-3161.
Provider Joint Training Opportunities
Check out Joint Provider Trainings link from HHSC, for more info:
https://apps.hhs.texas.gov/providers/training/jointtraining.cfm#course_112
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.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_j_intermcare.pdf
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R178SOMA.pdf
Appendix Q of SOMA (Immediate Jeopardy) Changes
CMS clarifications letter
SOMA appendix Q Section Immediate Jeopardy
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_q_immedjeopardy.pdf
LON & Facility Size |
Current Rates |
Proposed Rates |
SMALL |
|
|
LON 1 |
$144.25 |
$150.31 |
LON 5 |
$160.74 |
$167.90 |
LON 8 |
$182.82 |
$191.85 |
LON 6 |
$223.88 |
$236.59 |
LON 9 |
$406.11 |
N/C |
MEDIUM |
|
|
LON 1 |
$118.04 |
$123.14 |
LON 5 |
$134.06 |
$140.24 |
LON 8 |
$158.90 |
$166.92 |
LON 6 |
$190.24 |
$200.79 |
LON 9 |
$385.84 |
N/C |
LARGE |
|
|
LON 1 |
$112.09 |
$116.30 |
LON 5 |
$119.64 |
$124.64 |
LON 8 |
$133.22 |
$139.44 |
LON 6 |
$179.40 |
$188.96 |
LON 9 |
$387.25 |
N/C |
Joint Training From HHSC For Providers
Dec. 13th, 2022
Joint Training Page Available for HCS and TxHmL Program Providers
The HCS and TxHmL programs now have a Joint Training Opportunities page where providers can register for upcoming classes. Class size will be limited to maximize participation, but classes will be offered regularly. Providers should check the page often for updates. There will be recordings of special presentations available for viewing on-demand later.
Missed a COVID-19 training? Many COVID-19 presentations for long-term care providers are recorded and are available 24/7. Please be sure to select the most appropriate recording for your program. Note that recordings are accurate as of the date of presentation and that updated guidance may be available.
Visit the recording library at https://www.gotostage.com/channel/covid-19webinarsforltc.
Dec. 2022 HCS/TxHmL Provider Training Opportunities
Emergency Preparedness 101 for HCS and TxHmL Providers
Tuesday, Dec. 1311:30 a.m.–12:30 p.m.
HCS/TxHmL Program Provider Responsibilities in Death Reviews and Provider Investigating Reports
Wednesday, Dec. 211–2 p.m.
Writing Acceptable Plans of Correction for HCS and TxHmLThursday, Dec. 29
9 a.m.–4 p.m.Nacogdoches, Texas
Register here for in-person class
Oct./Nov. 2022 HCS/TxHmL Provider Training Opportunities
Top 10 Most Cited Deficiencies for HCS and TxHmL Providers (course description)
Wednesday, October 5, 20221:30 PM – 2:30 PM
Hurricane and Flooding Readiness for HCS/TxHmL (course description)
Wednesday, October 12, 20221:30 PM – 2:30 PM
Infection Control Basics for HCS and TxHmL Program Providers (course description)
Wednesday, October 19, 20222:00 PM – 3:00 PM
Emergency Preparedness 101 for HCS Program Providers (course description)
Tuesday, November 1, 20221:00 PM – 2:00 PM
July 2022 HCS/TxHmL Provider Training Opportunities
Long-term Care Regulation staff and program providers are invited to attend the following trainings hosted in July:
Writing Acceptable Plans of Correction for HCS and TxHmL
Wednesday, July 6
10:30 a.m.–12:30 p.m.
Register for the webinar.
Writing Acceptable Plans of Correction for HCS and TxHmL
Wednesday, July 6
10:30 a.m.–12:30 p.m.
Register for the webinar.
Hurricane and Flooding Readiness for HCS and TxHmL
Tuesday, July 12
1–2:45 p.m.
Register for the webinar.
Hurricane and Flooding Readiness for HCS and TxHmL
Tuesday, July 12
1:30–2:45 p.m.
Register for the webinar.
Administrative Penalties and Related Processes for HCS and TxHmL
Wednesday, July 20
1:30–2:45 p.m.
Register for the webinar.
Administrative Penalties and Related Processes for HCS and TxHmL
Wednesday, July 20
1:30–2:45 p.m.
Register for the webinar.
Infection Control Basics for HCS and TxHmL
Thursday, July 28
1:30–3 p.m.
Register for the webinar.
Additional classes may be added, and all available training opportunities can be found on the following websites:
July 5th, 2022
Nursing in HCS and TxHmL Settings -Recorded Session: April 5th, 2022
This three-hour webinar covers requirements for the provision and delegation of nursing care in HCS and TxHmL settings. A Texas Board of Nursing representative will be a guest presenter. The most frequently cited deficiencies related to these requirements will be noted during the training. No CEs are offered for this webinar. However, a certificate of attendance will be provided.
**You can still watch the recording from this session, click on the registration link below.
From April 5, 2022
11 a.m. – 2 p.m.
Register here for the webinar.
Registration is limited. A recording will be available after the presentation for those unable to attend. Contact LTCR Policy with questions.
HHSC Complaint and Incident Intake Voicemail Reporting Option Ends on Dec. 31 (ICF/IID)
December 11th, 2022
The provider self-reporting voicemail option will be transitioned out of service on Dec. 31, 2022. Effective Jan. 1, 2023, provider self-reported incidents must be submitted using one of the methods indicated below:
This does not apply to HCS or TxHmL, only ICF and other LTC programs such as ALF’s, SNF’s, DAH’s…
- Online via Tulip
- Email ciicomplaints@hhs.texas.gov
- Call 800-458-9858 (available Monday–Friday, 7 a.m.–7 p.m.)
Please ensure that all initial self-reported incidents include the relevant information detailed in Provider Letter 18-20.
HHSC Retires LTCR Provider Investigations Policy Mailbox
December 11th, 2022
The Health and Human Services Commission (HHSC) created the Regulatory Services Division in 2017 as regulatory functions consolidated from the Department of Family and Protective Services, the Department of Aging and Disability Services and the Department of State Health Services. As part of this consolidation effort, effective Jan. 30, 2023, HHSC will retire the Provider Investigation policy mailbox at PIPolicy@hhs.texas.gov.
For questions about investigations, please use the Long-term Care Regulation Policy and Rules mailbox at LTCRPolicy@hhs.texas.gov.
New VPN (HCS/TxHmL) For TMHP Claims
December 10th, 2022
Know that effective December 22, 2022, all HCS/TxHmL providers will need to have migrated to Palo Alto VPN for billing claims!
IMPORTANT: Clarification on HCS/TxHmL IPC Status in “Pending DADS Review”
December 06th, 2022
Please see this alert that was just sent to the 3 IDD associations from HHSC
ISS (Individualized Skills & Socialization) Provider Webinar Recording
Recording of Individualized Skills and Socialization- Provider Licensing Application Process Webinar
December 06, 2022
If you were not able to listen to the November 30th webinar on navigating TULIP/applying for an ISS license, the recording of the webinar and the presentation are now posted. See below for details. Though assumed that persons who listen to the recording will also be able to download a certificate, HHSC has yet to confirm that
Listen to the webinar recording.
Read the Individualized Skills and Socialization webinar (PDF).
Any questions or requests for transcripts may be emailed to LTCR Policy.
Recording of Individualized Skills and Socialization Provider Webinar
HHSC hosted the Individualized Skills and Socialization Provider Webinar on July 19 and Aug. 22 for Home and Community-based Services, Texas Home Living, and Deaf Blind with Multiple Disabilities program providers.
This webinar — offered on Tuesday, July 19, from 2:30–4:30 p.m. and on Monday, Aug. 22, from 2–4 p.m. — provided information on the upcoming new service, individualized skills and socialization. Both webinars will provide the same information, so program providers can register for the time that works best for them.
Below are the links to the recorded sessions from July 19th and 22nd. Please just click, register, and the presentation will begin.
Register now for the July 19 webinar.
Register now for the Aug. 22 webinar.
Handout: Read the Individualized Skills and Socialization Provider Webinar (PDF).
Email HCS Policy and LTCR Policy for questions and to request a transcript of the webinar or ask questions.
Email questions about the webinar to your program policy inbox:
July 19 Individualized Skills and Socialization Provider Webinar Recording Available
A recording of the July 19 Individualized Skills and Socialization Provider Webinar with HHSC Long Term Care Regulation and HHSC Long Term Services and Supports is available for those who could not attend. The webinar recording and slides have been posted to the Individualized Skills and Socialization webpage, the HCS and TxHmL Webinars & FAQs webpage, and the DBMD Provider Training, Webinars and Podcasts webpage.
Read the Individualized Skills and Socialization Provider Webinar (PDF).
Email HCS Policy and LTCR Policy for questions and to request a transcript of the webinar.
Pre-enrollment Site Visit Required for HCS and TxHmL Providers That Enrolled Through PEMS
December 1st, 2022
Home and Community-based Services and Texas Home Living waiver program providers that enrolled through the Texas Medicaid and Healthcare Partnership Provider Enrollment and Management System will be subject to a pre-enrollment site visit from TMHP. Read the full alert.
Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program providers that enrolled through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS) will be subject to a pre-enrollment site visit from TMHP.
The pre-enrollment site visit is required for enrollment in Texas Medicaid. The HCS program site visits will be conducted at the locations listed on the enrollment application, including the business office and any locations where clients receive residential assistance services.
A TMHP site visit coordinator will reach out through email or phone to schedule a visit. If the TMHP site visit coordinator is unable to reach the provider, then TMHP will conduct an unannounced site visit.
If providers have questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7)
A few items I want to make you aware of if you are a new HCS/TxHmL Provider Applicant:
- They may want to know what services you intend to use to bill via TMHP.
- i.e. TMHP billing specialist, or billing agency, someone at your agency using only TMHP or also specific outside software to make it easier to monitor and complete your billing (i.e. Millen Pro Billing services and/or software), or via Electronic Health Records for instance that have TMHP and EVV billing capabilities (TaskMaster Pro, TMHP, etc..)
- You do not have to have a group home when they visit before you have a contract. You don’t have clients yet and HCS does not require you to purchase or rent a home prior to receiving your contract. (Adult Mental Health HCBS program does require you have a home)
- You do not have to have a rented business office or “storefront”. You can use your “home office”. But you may need to explain how you intend to see your clients, meet potential families and clients or do staff trainings and still maintain privacy. Perhaps you can ask your local LIDDA’s if they have meeting spaces available to the providers, or you may use virtual office space, hotel conference/meeting rooms, and any staff training for group homes that will happen in the group home for example..
- Make sure if it is a home office, that it really is a delegated space for your office.
- They may want to know how you plan to maintain privacy and security with client records electronically stored, transferred, shared, or disposed of.
Determination of Intellectual Disability Information Update

December 1st, 2022
Texas Health and Human Services Commission (HHSC) updated the following information regarding the Determination of Intellectual Disability (DID):
- DID Best Practice Guidelines website
- DID Best Practice Guidelines (PDF)
- Become a Certified Authorized Provider to Conduct a DID website
For more information, email the IDD Services Team.
LTC Online Portal Enhancements for HCS and TxHmL Waiver Programs- Starting December 2022
December 1st, 2022
Overview of Upcoming LTC Online Portal Enhancements for HCS and TxHmL Waiver Programs
On December 12, 2022, the Texas Medicaid and Healthcare Partnership will implement several enhancements to the TMHP Long-Term Care Online Portal. After the enhancements are implemented, existing information and training materials will be updated. Read full alert.
-IPC Forms
-Termination Forms
-Pre-Enrollment Forms
-Individual Movement (IMT) Local Authority (LA) Reassignment Forms
-Provider Location Update (PLU) Forms
Other System and Form Enhancements
The Inactivate and Correct this Form buttons on the 8578 Intellectual Disability/Related Condition (ID/RC) Purpose Code (PC) 2 and Initial Enrollment IPC forms will be available only to HHSC staff.
This will decrease the potential for pre-enrollment and enrollment forms to get out of sync, as well as decreasing unnecessary form inactivations.
Account Preparation and Additional Resources
To prepare for these changes, HCS and TxHmL providers and LIDDAs that do not have an LTCOP account need to create an administrator or user account. Providers and LIDDAs can find instructions for creating an account in the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide (QRG).
Additionally, providers and LIDDAs are encouraged to visit the TMHP 1915(c) Waiver Programs web page for recent news, reference materials, education, and bulletins.
For more information, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7).
October 23rd, 2022
LTC Portal Enhancements: Coming Soon!
Beginning in December 2022, several enhancements will be implemented for the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal. The enhancements will improve form submission and portal functionality. Information about these upcoming changes will be available in future articles on the TMHP 1915(c) Waiver Programs web page.
Account Preparation and Additional Resources
To prepare for these changes, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers and local intellectual and developmental disability authorities (LIDDAs) that do not have an LTC Online Portal account need to create an administrator or user account. Providers and LIDDAs can find instructions for creating an account in the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide (QRG), which is available in the TMHP Learning Management System (LMS), and on the TMHP website.
Note: To access the LMS, register for the LMS by clicking the Don’t Have an Account? Sign Up Here button beneath the login field.
(FYI-This includes HCS/TxHmL provider applicants who are going to have their contracts approved soon to begin services. If you haven’t signed up for the LTC Portal yet, please do so!)
Additionally, TMHP encourages providers and LIDDAs to visit the TMHP 1915(c) Waiver Programs web page for recent news, reference materials, education and bulletins.
For more information, contact the TMHP LTC Help Desk at 800-626-4117, option 1, then option 7.
American Rescue Plan Act (ARPA): Provider Retention Payments Regarding HCS/TxHmL Billing Claims from March 2022-August 2022
November 14th, 2022
Don’t forget: HHSC has extended the time for any providers eligible for these ARPA payments to complete the attestation, so that the initial and final reports are not due, until 30 calendar days after the end of the COVID Public Health Emergency (PHE).
July 4th, 2022
American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments
Initial report is now due by August 15, 2022.
The Texas Health and Human Services Commission (HHSC) implements American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention payments.
HHSC is providing funds to agency providers and consumer-directed services employers to support recruitment and retention efforts for direct care staff delivering HCBS services. Payments made under this section can include one-time financial compensation directed toward direct care staff, including lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
Providers who may be eligible to receive funds are:
- 1915 (c) Texas Home Living (TxHmL) Provider Agency
- 1915 (c) Home and Community-Based Services (HCS) Provider Agency
- 1915(i) Home and Community-Based Services – Adult Mental Health (HCBS – AMH) Provider Agency
- 1915 (c) Home and Community-Based Services (HCS) CDS Employer
- 1915 (c) Texas Home Living (TxHmL) CDS Employer
- see the HHSC HCBS website for other types of additional information on ARPA funds.
HHSC is providing time-limited reimbursement increases to strengthen and stabilize the HCBS workforce. Temporary rate increases will be made on eligible HCBS service claims with dates of service between March 1, 2022, and August 31, 2022.
Providers receiving temporary rate increases must complete an attestation and complete an initial report by August 15, 2022.
HHSC will announce the due date for the final report in a follow-up notice. Providers will have at least 30 days to complete the final report.
Providers who fail to complete the required attestation and reporting will be subject to recoupment of HCBS ARPA funds.
Consumer Directed Services (CDS) Employers and Financial Management Services Agencies (FMSAs)
The CDS participant, as the employer of record, may choose to submit the required attestation and reports or work with the Financial Management Services Agency (FMSA) to submit the attestation and reports on the CDS participant’s behalf. FMSAs may also reach out to the CDS participants to offer assistance in submitting the attestation and reports. FMSAs can submit the required information for multiple CDS participants in the FMSA HCBS ARPA Attestation and Initial Report Template. Pursuant to Texas Administrative Code rule 1 TAC 355.207(c)(4), to be eligible for the temporary rate add-on, providers must submit required reports regarding the use of funds and provide data to document vacancy rates in direct care staff and other indicators. If completing the attestation and reports on behalf of a CDS participant, FMSAs should work with the CDS participant to collect all required data. The deadline for the attestation and initial reporting has been extended to August 15, 2022.
Information regarding ARPA HCBS Provider recruitment and retention payments is available on the HHSC Provider Finance website.
June 2nd, 2022
Don’t Forget!
American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments Attestation and Initial Reporting
Initial report is due by July 1, 2022.
The Texas Health and Human Services Commission (HHSC) implements American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention payments.
HHSC is providing funds to agency providers and consumer-directed services employers to support recruitment and retention efforts for direct care staff delivering HCBS services. Payments made under this section can include one-time financial compensation directed toward direct care staff, including lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
HHSC is providing time-limited reimbursement increases to strengthen and stabilize the HCBS workforce. Temporary rate increases will be made on eligible HCBS service claims with dates of service between March 1, 2022, and August 31, 2022.
Providers receiving temporary rate increases must complete an attestation and complete an initial report by July 1, 2022.
HHSC will announce the due date for the final report in a follow-up notice. Providers will have at least 30 days to complete the final report.
Providers who fail to complete the required attestation and reporting will be subject to recoupment of HCBS ARPA funds.
Information regarding ARPA HCBS Provider recruitment and retention payments is available on the HHSC Provider Finance website.
May 19th, 2022
HCS/TxHmL providers:
Please be aware of the following for claims being paid from March 1st, 2022-August 31st, 2022 in TMHP: There are new Procedure/Billing Codes in TMHP that reflect the ARPA short-term funding as retention payments you may be receiving for these claims billed during this time period. If you are seeing new or different codes than you are used to, listed when you pull up “paid” claims, then you are receiving ARPA Retention payments and will be responsible for documenting how these funds were used and reporting this by July of 2022, or you are subject to recoupment from the MCO’s. (Example: M0115, M0116, M0117…)
See rates and new codes listed in link below:
https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:cca5939a-6173-346e-9fc2-3409490a5447
Personally, I was under the assumption that providers would have to request this assistance if they wanted it, meaning they would choose whether they utilized this funding or not. Apparently not necessarily as some providers have noted this is showing up on their payments. From everything I am reading, the provider letters from HHSC do seem to indicate every provider will receive the funding.
Meaning additional (ARPA) monies that the provider is receiving in claim payments for that time period, will need to be accounted for, and reporting on how funds were utilized will need to happen and be sent into HHSC. Some providers are noticing a difference in the regular rates they submitted claims for when they look at their “paid claims”. If the provider uses the ARPA intended, attestation and reporting to HHSC must occur.
If the HCS/TxHmL provider chooses not to utilize the added-on payments to the normal rates, I believe they will need to hold back/save these additional amounts for each claim paid from March to August of 2022, in order to pay them back at a later date. If these ARPA funds are utilized, then the HCS/TxHmL Provider will need to complete a report by July of 2022. I believe, to HHSC by the provider, or they will have to keep it in an account and saved for repayment/recoupment when requested by the MCO’s if I understand correctly. I will keep you posted! Also, please look for the additional FAQ’s to be published on May 23rd, 2022 for hopefully important answers to the TMHP questions and issues many providers have expressed with entering IPCs in particular (especially revisions) entering billing claims, and only getting paid for part of billing claims submitted.
Here Are Just Some Of The FAQ’s HHSC Recently Published May 5th, 2022 (specifically related to this issue I have noted above)
Q: What are the ARPA HCBS Provider Retention Payments?
A: HHSC’s ARPA HCBS spending plan included recruitment and retention payments for providers delivering attendant and direct care HCBS for retention bonuses or other activities. HHSC’s spending plan requires providers to use at least 90 percent of HCBS ARPA funds for one-time financial compensation for their direct care workforce, including, but not limited to, lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
Q: What Services are eligible for Provider Retention Payments?
A: HCBS ARPA temporary rate add-on will be applied to HCBS personal attendant and nursing services as defined in 1 TAC 355.207. A list of eligible services is defined in Section 355.207(b)(1). An updated service list and fee schedule is available on the Provider Finance Homepage.
Q: What identifying information do I need to include with my attestation and required reports?
American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments
The Health and Human Services Commission (HHSC) American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments is part of the HHSC APRA Spending Plan.
The HCBS ARPA Retention Payments will be distributed as a temporary rate add-on to agency providers and consumer-directed services employers to support recruitment and retention efforts for direct care staff delivering HCBS services. Eligible providers can use the temporary add-on to provide one-time financial compensation directed toward direct care staff, including lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
HHSC adopted a new Texas Administrative Code rule 1 TAC 355.207 governing the HCBS ARPA Retention Payments, including the attestation and reporting requirements. Eligible providers who receive the add-ons but fail to complete the required attestation and reporting will be subject to recoupment of the associated payment add-ons.
Click here to submit the required attestation and initial report due July 1, 2022.
HHSC will provide additional information regarding the due date for the Final report at a later date. Providers will have at least 30 days to submit the final report.
- View HCBS ARPA Eligible Services and Rate Add-on Fee Schedule (.pdf)
- View HCS and TxHmL Rate Add-on Fee Schedule for Bill Codes effective after 05-01-2022 (.pdf)
- View Provider Information Letter IL-2022-30 (.pdf)
- View HCBS ARPA Frequently Asked Questions (.pdf)
Please contact the HHSC Provider Finance Department, Long-term Services and Supports Customer Information Team at PFD-LTSS@hhs.texas.gov or (512) 867-7817 if you have questions regarding HCBS ARPA Provider Retention Payments.
TMHP Enhancements Release Dates
November 11th, 2022
TMHP Enhancements
According to HHSC the enhancements (improvements) planned for release this month will most likely be posted later this week or early next week. These posted enhancements will not be effective until Dec. 12, 2022.
HHSC will go over these enhancements in depth at the December 8th, 2022 Migration Webinar
September 23rd, 2022
There are 2 sets of HHSC and TMHP ‘enhancements’ (or ‘fixes’ or ‘improvements’ to the system) to be released in the near future. HHSC has said that the first set of ‘enhancements’ will be released November 4, 2022, and the second set will be released in June of 2023.
Public Health Emergency (PHE) Status
November 11th, 2022
At this time, according to HHSC the PHE is set to end on January 11, 2023. Currently, it is not known whether it will be extended beyond January 11th, 2022. It is possible providers will be notified this week in some alerts if PHE will be extended beyond January 11, 2023.
Why is this important?
*This is important as COVID-19 flexibilities may end and Medicaid status may be lost for those individuals in our waiver and ICF programs where provider has not responded to previous warning letters from CMS that their Medicaid status will not automatically be renewed without reapplying.
THERAP Information and Resources
Previous Webinars Hosted ByTwogether Consulting: Therap during our free resource webinar series below. Just click on the links and register.
October 2022
https://attendee.gotowebinar.com/recording/2347988816141652494
August 2022
https://attendee.gotowebinar.com/recording/1388286687336697103
If you need assistance with your current Therap services or with information on getting these services, please contact:
Calvin Christensen(Business Development Consultant at Therap Services, LLC)
Here is his LinkedIn page
https://calendly.com/calvin-christensen/system-demonstration?back=1&month=2022-10
Other Resources
Overview of new pharmacy interface feature with orders, MARS, etc…
Overview of GER Reports (Incidents, Injuries, Med Errors…)
https://help.therapservices.net/app/general-event-reports
https://www.therapservices.net/
For more information on Therap please see link below:
https://www.therapservices.net/products/comprehensive-esolution-for-texas-providers/

Data-Driven:
Person-centered solutions your organization can use to support agency workflows, communication, compliance, organizational outcomes, and revenue management
HCS Provider Letters, Contacts and Resources
October 27th, 2022
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 email updates, using this GovDelivery signup, and select Information Letters, Provider Alerts and the contract program type(s).
When you sign up for email updates, you are giving your information to both HHSC and to Granicus. When HHSC has your information, it is subject to the HHSC privacy policy. When Granicus has your information, it is subject to the Granicus GovDelivery privacy policy.
Contact Program Staff
- Provider/policy information: hcs@hhsc.state.tx.us / hcspolicy@hhsc.state.tx.us
- Contracting information: 512-438-3234 / IDDWaiverContractEnrollment@hhsc.state.tx.us
- Eligibility information: Your local authority
- Regional nurses: Community Services regional contacts for your region
Resources
COVID FAQ’s & Guidance
- Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF) – revised July 22, 2022
- COVID-19 Response for HCS Residential Providers (PDF) – revised June 24, 2022
Infection Control & Vaccine Resources
- 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)
HB 3720
Surveyor Review Tools and Forms
- Form 1573, Residential Review Evidence of Correction for Results Less Than 90%
- Form 3609, Waiver Survey and Certification Residential Checklist
- Form 5611, Waiver Survey and Certification — HCS Personnel Checklist
- Form 5607, Waiver Survey and Certification DFPS Checklist
- Form 5610, Fire Drills
- Form 8576, Individual Profile Information
- Form 8608, Sample Appeal Letter
Additional Resources
- Provider and LIDDA CARE Report Crosswalk
- Provider and LIDDA CARE Screen Crosswalk
- Comprehensive Nursing Assessment FAQ (PDF)
- HCS and TxHmL Transformation Webinar (PDF)
- Interpretive Guidance Booklet (PDF)
- HCS & TxHmL Certification Principles Webinar Series: Participant Q&A (PDF)
- Regulation of Individual Skills and Socialization webinar (PDF)
- Regulation of Individual Skills and Socialization webinar Recording
TaskMaster Pro Information & Resources
October 31st, 2022
Previous Webinars Hosted ByTwogether Consulting: TaskMaster Pro (TMP) during our free resource webinar series below.
Just click on the links and register.
October 20th, 2022
https://attendee.gotowebinar.com/recording/1488497278022599682
We couldn’t find an innovative IDD Practice Management software that focused on delivering better care, so we built one!
Software features for Service Providers
Our IDD software is designed by Service Providers and built for Service Providers. Every day we face the same challenges you do in providing care to the people in our IDD community. So that delivering the best care possible can be the focus, we designed TMP to be easy to use, intelligent, and robust.
Care professionals are led quickly through documentation processes with platform-assisted data completion. No repetitive entry of information, it’s fast and accurate. Compliance data is gathered and tracked simultaneously. This means compliance reporting can be completed at the push of a button. Thus, caregivers spend more time giving care and less time on paperwork.
Have more questions? Please schedule a free demo below.
And don’t forget to mention if you found out about us through Twogether Consulting!
Monthly Webinars on Migration of CARE to TMHP
January 15th, 2023
Jan. 11th TMHP LTC Migration Webinar
- R & S Video Series for LTC Providers & FMSAs: There are 3 videos related to this topic:.
October 23rd, 2022
Oct. 5 TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar Recording Available
A recording of the Oct. 5 TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar is available for those who could not attend.
The webinar recording and slides have been posted to the HCS and TxHmL Webinars & FAQs webpage.
For questions, email TxHmL Policy.
October 13th, 2022
Monthly Meetings/Webinars On Migration To TMHP LTC Portal for HCS/TxHmL/FMSA’s
Medicaid and CHIP Services (MCS) will begin hosting monthly meetings for Providers and Financial Management Services Agencies (FMSAs) who use the Long-Term Care (LTC) Online Portal for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs, beginning in October will be held to discuss trending issues, share solutions established to address barriers providers and LIDDAs are experiencing, answer questions, etc.
Texas Medicaid & Healthcare Partnership (TMHP) and Health and Human Services Commission (HHSC) staff from the following departments will be available to provide information and answer questions:
- Program Eligibility and Support (PES).
- Utilization Review (UR).
- Provider Claims Services (PCS).
- Contract Administration & Provider Monitoring (CAPM).
- Local Procedure Development and Support (LPDS).
Save the Dates
The webinars will be held on the following dates. We encourage Providers and FMSAs to invite staff who use the LTC Online Portal for HCS and TxHmL programs.
- October 2022: Wednesday, Oct. 5, 1–2 p.m. Register for the webinar.
- Here is a copy of the handout from October 5th, 2022, if you missed the webinar. The recording of that session will be posted in the near future.
- November 2022: Wednesday, Nov. 9, 10–11 a.m. Register for the webinar.
- December 2022: Thursday, Dec. 8, 1–2 p.m. Register for the webinar.
Standing Meeting Agenda
- Trending issues – discuss trending issues and solutions to increase successful processing of forms.
- Updates on LTC Online Portal for HCS and TxHmL – provide relevant updates.
- Questions and Answers – HCS and TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding LTC Online Portal for HCS and TxHmL.
*To comply with HIPAA requirements, questions that include any identifying information for a specific individual will not be allowed during the monthly meetings.
Email Questions to TxHmL Policy.
Don’t Forget To Get Ready For Flu Season!
October 17th, 2022
From HHSC:
LTC Providers Encouraged to Get Ready for Flu Season
CDC recommends everyone be vaccinated against the flu by the end of October to avoid peak flu season. Long-term care providers should review their program requirements for guidance related to vaccination requirements and infection control.
Some of the CDC’s recommendations for vaccinating patients in congregate healthcare settings are:
- The CDC recommends that LTC facilities offer the flu vaccine to all residents and healthcare staff throughout the flu season.
- Residents with close contact to someone with COVID-19 and asymptomatic and pre-symptomatic residents in isolation can be vaccinated.
- For residents with suspected or confirmed COVID-19 who are symptomatic, healthcare personnel can postpone their vaccine until meeting the criteria for discontinuing isolation. The person should not be considered moderately or severely ill and should have fully recovered from acute illness as recommended by the CDC.
Administer COVID-19 vaccines without regard to the timing of other vaccines. This includes administering the COVID-19 and flu vaccines at the same time. Access the CDC’s COVID-19 vaccine and coadministration with other vaccines for more information.
Adhere to standard precautions. They are the foundation for preventing the transmission of infectious agents in all healthcare settings and help prevent the flu.
Implement droplet precautions for those with suspected or confirmed flu. Do this for seven days after illness onset or until 24 hours after the fever and respiratory symptoms resolve, whichever is longer, while the person is in a long-term care facility.
Per TAC Title 25, Part 1, Chapter 97, report all outbreaks to the local health department, regardless of the provider type. Contact information for your local health department is on the DSHS website.
For more information, view:
Texas Culture Change Coalition Conference-“A Day Focused On Person-Centered Senior Care” Nov. 3rd, 2022-Austin, Tx
October 16th, 2022
Register for Texas Culture Change Coalition Conference
The Texas Culture Change Coalition will host their in-person fall 2022 conference, “Texans Coming Together for Residents, for Staff, for All!”
This year’s theme is “A Day Focused on Person-Centered Senior Care.”
Nov. 3
8 a.m.–5 p.m.
Commons Conference Center (J.J. Pickle Research Campus)
10100 Burnet Road, Bldg. 137
Austin, TX 78758
Continuing education credit for multiple disciplines will be provided for this event.
For more information, visit the Texas Culture Change Coalition website.
HCS Provider Response & Visitation Emergency Rules: COVID-19-Update 2022
October 17th, 2022
HHSC HCS Program Provider Response to COVID-19 Emergency Rule Expired Oct. 14
The emergency rule for Home and Community-based Services waiver program providers that contain the HCS Program Provider Response to COVID-19 Emergency Rule expired Oct. 14.
The following rule expired Oct. 14:
- 40 Texas Administrative Code Section 9.198 – Program Provider Response to COVID-19 Emergency Rule
HCS program providers must continue to comply with visitation requirements for essential caregivers and clergy in a disaster located in TAC Chapter 570 as well as all other applicable rules and certification principles.
See Section 9.198 below:
40 Tex. Admin. Code § 9.198
July 11th, 2022
Provider Letter 2022-13, Version 2: Petition To Suspend Essential Caregiver Visits
HHSC issues PL 2022-13, Version 2 with additional information regarding how a facility or program provider may petition HHSC to suspend in-person essential caregiver visits.
Read PL 2022-13, Version 2 here.
“A facility or program provider may petition HHSC to suspend in-person
essential caregiver visits for no more than 7 consecutive calendar days
if in-person visitation poses a serious community health risk. To
petition for a suspension of in-person essential caregiver visits, a
facility or program provider must submit a request to their Regional
Director (RD) by email. The contact information for each Regional
Director is available on the Long-term Care Regulatory Regional
Contact Numbers website. A facility or program provider may request
an extension from HHSC to suspend in-person essential caregiver
visitation beyond the original request, but HHSC may not approve an
extension that exceeds 7 days. HHSC may deny a petition to suspend
in-person essential caregiver visits if HHSC determines that in-person
essential caregiver visits does not pose a serious community health
risk.”
July 5th, 2022
Updated HCS/TxHmL COVID-19 Response Plan, FAQ Documents- June 24th
HHSC Long-term Care Regulation updated the COVID-19 Response Plan and FAQ documents on June 24. The updates remove instructions on how to ask for emergency staffing from HHSC.
Read the revised COVID-19 Response for HCS Providers (PDF).
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
May 7th, 2022
Updated HCS/TxHmL COVID-19 Response Plan, FAQ Documents-May 5th
HHSC Long-term Care Regulation updated the COVID-19 Response Plan and FAQ documents on May 5. The updates remove instructions on how to ask for emergency staffing from HHSC.
Read the revised COVID-19 Response for HCS Providers (PDF).
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
February 20th, 2022
Updated HCS COVID-19 Response Plan and FAQ Documents – Feb. 18
HHSC Long-term Care Regulation updated the HCS COVID-19 Response Plan and FAQ documents.
Read the revised COVID-19 Response for HCS Providers (PDF).
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
Updated COVID-19 Provider Response and Visitation Emergency Rules for HCS Providers – Feb. 17
HHSC Long-Term Care Regulation published revised HCS COVID-19 Provider Response to COVID-19 and Expansion of Reopening Visitation Rules (PDF). HCS providers must now screen individuals and staff per HHSC guidance.
HHSC Long-Term Care Regulation published revised COVID-19 Expansion of Reopening Visitation Emergency Rules. They are for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions program providers. HHSC removed the following language:
“If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this rule or any minimum standard relating to a facility, the facility must comply with the executive order or other direction.”
The rules became effective Feb. 17, 2022.
January 7th, 2022
HCS and TxHmL COVID-19 Response Plan Updated – Jan. 7th, 2022
HHSC has revised the HCS and TxHmL COVID-19 Response Plan in response to the most recent CDC guidance.
September 23rd, 2022
HCS COVID-19 Mitigation & Expansion of Visitation Rules:
Revision Response Plan
COVID-19 Response Plan (PDF) in response to the revised HCS and TxHmL COVID-19 Mitigation and Visitation rules
Update: April 17th, 2021
HHSC Publishes HCS Expansion of Reopening Visitation Rules
Original Published: March 25th, 2021
3.0 HCS Expansion of Reopening Visitation Rule
To read more, please click on the link below:
https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:a7d8cd88-7334-4f8b-89b3-5876693ceb1a
*** Please Don’t Forget To Update Your Policies & Procedures Based On The Changes. Feel Free To Contact Twogether Consulting For Assistance! Info@twogetherconsulting.com
The new expanded visitation rules do not apply to host home/companion care providers unless otherwise specified in rule. See the HCS Provider Response to COVID-19 Expansion of Reopening Visitation Rule at 40 TAC 9.199 for the complete list of requirements.
The new visitation rules provide flexibility for HCS program providers that have offered a complete series of a one- or two-dose COVID-19 vaccine to individuals and staff and documented each individual’s choice to vaccinate or not vaccinate, including:
• Essential caregiver and end-of-life visits are permitted for all individuals with any COVID-19 status.
• The definition of an end-of-life visit has been expanded to include for more flexibility on when an individual is considered at end-of-life so an individual’s family and loved ones have more opportunity to visit.
• Indoor visitation no longer requires the use of a plexiglass barrier.
• A program provider may not require a visitor to provide documentation of a COVID-19 negative test or COVID-19 vaccination status as a condition of visitation or to enter the residence.
• Provider staff no longer have to escort or monitor visitors once they have passed screening and entered the facility.
• Program providers are no longer required to submit an attestation form to facilitate visitation.
• Visitation is required and a program provider must facilitate indoor and outdoor visitation without a reasonable clinical or safety cause.
The provider can continue to document the individual’s choice whether to receive a COVID-19 vaccine or not to receive a COVID-19 vaccine as applicable for new admissions or individuals who return to the residence from leave.
Visitor Limitations: (Indoor and Outdoor)
3.3 Indoor and Outdoor Visits
HCS program providers that have offered a complete series of a one- or two-dose COVID-19 vaccine to individuals and staff and documented each individual’s choice to vaccinate or not vaccinate, must allow indoor and outdoor visitation.
Program providers do not have to complete an attestation form or use plexiglass barriers to facilitate indoor or outdoor visitation. The program provider accommodates visitation based on the space available as necessary to ensure physical distancing between visitation groups and safe infection prevention and control measures.
3.3.1 Indoor Visitation
• The program provider must allow indoor visits for individuals who are COVID-19 negative, if there are no confirmed COVID-19
infections or suspected COVID-19 cases for at least 14 consecutive days among staff. • The provider must reasonably limit the number of simultaneous visitors per individual and limit the total number of visitors in the residence simultaneously, based on the size of the building and physical space and staffing capabilities.
• Plexiglass barriers are no longer required.
3.3.2 Outdoor Visitation
The program provider must allow outdoor visits for individuals who are COVID-19 negative and must:
• ensure a comfortable, accessible, and safe outdoor visiting area for outdoor visits, considering outside air temperatures and ventilation; and
• limit the duration, frequency, size, and number of visits as necessary to ensure physical distancing between visitation groups and safe infection prevention practices.
3.3.3 Limitations for Visitation
The following limitations apply to all visitation types, including essential caregiver visits, end-of-life visits, and indoor and outdoor visitation:
• Visits must be scheduled to allow time for cleaning and sanitization of the visitation area between visits.
• Indoor and outdoor visits are permitted for individuals with COVID-19 negative status only, except essential caregiver and end-of-life visits. Essential caregiver and end-of-life visits are permitted for an individual with any COVID-19 status.
• The visitor and individual they are visiting do not have to physically distance from each other but must distance from other persons in the residence.
• The visitor must wear a face mask or face covering. For individuals who rely on lip reading or facial cues for communication needs, the visitor may use face masks with a clear screen over the mouth.
• The provider must encourage the individual to wear a face mask, if tolerated, throughout the visit.
• When visitors come to the home, staff members no longer need to escort the visitor or monitor the visit, regardless of the visitation type.
• Both the individual and visitor(s), must perform hand hygiene (i.e., use an alcohol-based hand sanitizer or wash hands with soap and water) before the visit. The program provider must make hand hygiene supplies available.
Limited Visitation Designation and Attestation
4.0 Limited Visitation Designation and Attestation Requirements
If an HCS program provider has not offered at least one complete series of a one- or two-dose COVID-19 vaccine to individuals and staff, the program provider may allow limited personal visitation.
4.1 Essential Caregiver Visits
An essential caregiver visit is defined as a personal visit between an individual and a designated essential caregiver, permitted for all individuals with any COVID-19 status, including:
• COVID-19 negative;
• unknown COVID-19 status; or
• COVID-19 positive.
A program provider cannot require an essential caregiver visitor to provide documentation of a negative test result prior to visitation. The following requirements apply to essential caregiver visits:
• There may be up to two permanently designated essential caregivers per individual.
• Only one essential caregiver visitor at a time may visit an individual.
• The visit may occur outdoors, in the individual’s bedroom, or in another area in the home that limits the essential caregiver visitor’s movement through the residence and interaction with other individuals and staff.
• Essential caregiver visitors do not have to maintain physical distancing between themselves and the individual they are visiting but must maintain physical distancing between themselves and all other persons in the residence.
• The individual must wear a face mask or face covering over both the mouth and nose (if tolerated) throughout the visit.
• The program provider must develop and enforce essential caregiver visitation policies and procedures, which include:
o a written agreement that the essential caregiver visitor understands and agrees to follow the applicable policies, procedures, and requirement;
o training each essential caregiver visitor on proper personal protective equipment (PPE) usage and infection control measures, hand hygiene, and cough and sneeze etiquette; and
o a requirement that the essential caregiver visitor must wear a face mask and any other PPE in accordance with CDC guidance and the program provider’s policy while in the residence.
The program provider must:
• inform the essential caregiver visitor of applicable policies, procedures, and requirements;
• approve the essential caregiver visitor’s face mask and any other PPE in accordance with CDC guidance and the program provider’s policy, or provide an approved face mask and other PPE;
• maintain documentation of the essential caregiver visitor’s agreement to follow the applicable policies, procedures, and requirements;
• maintain documentation of the essential caregiver visitor’s training;
• maintain documentation of the identity of each essential caregiver visitor in the individual’s records and verify the identity of the essential caregiver visitor at the time of each visit;
• maintain a record of each essential caregiver visit, including:
o the date and time of the arrival and departure of the essential caregiver visitor;
o the name of the essential caregiver visitor;
o the name of the individual being visited; and
o attestation that the identity of the essential caregiver visitor was verified; and
• prevent visitation by the essential caregiver visitor if the essential caregiver has signs and symptoms of COVID-19, or an active COVID-19 infection.
The program provider can ask the essential caregiver to leave the residence if the essential caregiver visitor fails to comply with the program provider’s policy regarding essential caregiver visits or applicable requirements.
4.2 Limited Visitation without Attestation Form
All HCS residences can allow the following visits without completing the HCS Expanded Visitation Attestation:
• Visits by persons with legal authority to enter
• Visits by providers of essential services
• Visits by essential caregivers
• End-of-life visits
• Closed window visits
The visitors listed above must be screened prior to entry to the residence and cannot be allowed inside the residence if they fail screening.
Definitions and Attestation Form Update: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:a7d8cd88-7334-4f8b-89b3-5876693ceb1a
HHSC Publishes HCS Expanded Visitor Attestation Rules & Guidance Letter
September 25th, 2020
HHSC Visitor Expansion Rule. See the following rules in PDF updated on 9/25/20. https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/hcs/hcs-covid-19-updated-emergency-rules.pdf
PL-20-40 is the letter providing guidance for the new rules The new attestation form is at the bottom of this alert letter from HHSC. See the following PDF of PL-20-40: https://apps.hhs.texas.gov/providers/communications/2020/letters/PL2020-40.pdf
HCS Emergency COVID-19 Mitigation Rules
Click on link below to see new rules that were adopted!
HCS/TxHmL Proposed Rules: HCBS Setting Compliant
HCS/TxHmL proposed rules should align with the federal HCBS settings rule.
These are currently in the formal comment phase. These comments are due to HHSC on October 17, 2022. To view the rules and instructions for submitting comments, go to the following link: https://www.hhs.texas.gov/regulations/policies-rules/health-human-services-rulemaking/comment-proposed-draft-rules
New Critical Incident Management Reporting System: Updates
October 13th, 2022
Please Don’t Forget To Sign Up For CIMS Training
Only 200 of the 800 providers/users have completed the training and have signed in/register
Providers must start using CIMS by November 1st, 2022. If you are a member of one of the 3 IDD associations, HHSC will provide each of these associations with the names of those entities so each association can reach out to their respective IDD waiver members who are not on the list/have yet to complete these steps.
August 11th, 2022
Critical Incident Management System (CIMS) Now Live
HHSC announces the new Critical Incident Management System is now live. CIMS is a statewide tool for reporting critical incidents.
All providers must begin entering critical incidents into CIMS no later than Nov. 1.
See IL 2022-23 for more information about CIMS.
This alert applies to:
- Community Living Assistance and Support Services providers
- Deaf Blind with Multiple Disabilities providers
- CLASS case management agencies
- Home and Community-based Services providers
- Texas Home Living providers
- Local intellectual and developmental disability authorities
INSTRUCTIONS FROM HHSC FOR COMPLETING TRAINING AND CORRECTING/ADDING USERS:
“The provider administrator with the active user account created in CIMS is required to complete the training in the system. Once the provider administrator completes the training, provider administrators can begin adding new users to their organization and reassigning roles so other members of the organization can enter critical incidents into CIMS.
If the designated provider administrator still works for an organization, HHSC will not change the designated administrator for a provider organization. If the designated provider administrator no longer works for the organization, HHSC will work with the current designated employee to ensure that person is added as a user in CIMS. HHSC staff must verify the employee requesting CIMS access works for a contracted provider or a local intellectual and developmental disability authority before access can be granted.
Now that CIMS has gone live, providers can no longer change contact information in CARE or send provider administrator contact updates to HHSC if the provider administrator is employed with the organization.”
Providers are required to use current systems for entering critical incidents until they have completed CIMS registration and training and begin entering critical incidents into CIMS.
Email questions to the MCS-CIMS inbox.
April 12th, 2022
- Revised IL 2022-23: https://www.hhs.texas.gov/sites/default/files/documents/il2022-23.pdf
- CIMS Part II Webinar on April 26th: https://www.hhs.texas.gov/provider-news/2022/04/04/register-now-april-26-webinar-hhscs-new-cims-part-ii
- Due date for Correcting/Updating Contact Information extended to April 15th:
April 10th, 2022
Register Now for the April 26 Webinar on HHSC’s New CIMS Part II
HHSC is offering CLASS CMAs, CLASS DSAs, DBMD, HCS and TxHmL providers more information on the new Critical Incident Management System
debuting this summer. The webinar will be held:
Tuesday, April 26, 2022
2:30 – 4 p.m.
Register here to attend the New Critical Incident Management System Webinar.
From HHSC I-2022-23 revised letter:
The system is targeted to go live July 25, 2022. Prior to the go-live date, HHSC and FEI Systems will provide training on the new system for waiver provider staff who will use the CIMS to report critical incidents. There will be training provided by FEI Systems using webinar formats; however, there will be limited capacity and these trainings will be focused on staff using the CIMS to report incidents. Virtual training resources will be available and accessible to waiver provider staff in addition to the information provided during training webinars. The goal is to support waiver provider staff with virtual training available for reference at any time to support using the system.
April 10th, 2022
HHSC has Published Critical Incident Management System (CIMS) 1915(c) Medicaid Waiver Program Providers (Revised) IL-2022-23
IL-2022-23 is posted to the HHS site CLASS, LIDDA, DBMD, HCS, and TxHmL
This letter replaces Information Letter 2022-14 and is a status update on the CIMS implementation which impacts fee-for-service 1915(c) waiver program providers, CLASS Case Management Agencies and LIDDAs.
Submit questions to LTSS_Policy@hhs.texas.gov
February 27th, 2022
HHSC Publishes New Reporting System for Critical Incidents Management
(CIMS) See Letter (IL 2022-14)
(As if providers don’t have enough new things to learn, lol)
Sorry to say, we are gearing up for a new critical incident reporting system, and I know providers have so many other new things to learn between Migrating from CARE to TMHP, Utilizing the E-learning portal, EVV, etc.., but, HHSC has approved IL-2022-14 CIMS for CLASS, LIDDA, DBMD, HCS and TxHmL Providers.
The Health and Human Services Commission (HHSC) will implement a new statewide critical incident management system (CIMS) for reporting critical incidents. The new system will be in compliance with guidance issued by the Centers for Medicare and Medicaid Services (CMS) on March 12, 2014. There will be training sessions leading up to the implementation date of June 1st, 2022.
Questions about this project can be submitted to the following email address: LTSS_Policy@hhs.texas.gov
HCS and TxHmL Webinar Slated for March 10th, 2022
Program providers and other interested stakeholders can now register for the upcoming HCS and TxHmL webinar.
-
Webinar topics include:
- HCS & TxHmL Forms and Claims Migration Project
- Critical Incident Management System
HCS and TxHmL Webinar
March 10, 2022
3:30 – 4:30 p.m.
Register for the webinarEmail questions about the webinar to your program policy mailbox:
CARE Migration To TMHP HCS &TxHmL: Updates
October 13th, 2022
Update on Some Migration Issues
March 7th, 2022
Claims Training for CARE Migration:
“TMHP is hosting HCS and TxHmL Waiver Programs webinars on March 22 and March 24 for program providers, LIDDAs, and FMSAs who submit claims on behalf of CDS employers. These webinars will train attendees how to submit and manage claims using TexMedConnect.”
For more info, copy and paste this URL into your browser: https://www.tmhp.com/news/2022-03-09-texmedconnect-claims-submission-training-hcs-and-txhml-programs
February 9th, 2022
More Clarifications From HHSC: Migration During TMHP LTC Online Portal Outage:
February 8th, 2022
Very Important !!!! HCS & TxHmL Providers: Migration of CARE to TMHP
“Beginning March 1, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual developmental disability authority (LIDDA) agencies, and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) employers will submit claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP). It’s important that HCS and TxHmL program providers, LIDDAs, and FMSAs set up their accounts as soon as possible to avoid any delays in payment after March 1, 2022. Program providers, LIDDAs, and FMSAs are strongly encouraged to set up the following accounts if they have not already done so:
- Claims Submission Account
- TexMedConnect or
- Electronic Data Interchange (EDI)
- Long-term Care (LTC) Online Portal
- TMHP Learning Management System (LMS)”
To read more, please click on the link below: Don’t Delay!!!!
Clarifications:
We acknowledge that location errors can be tricky. Below is a list of some CARE screens to check and some hints for fixing the errors, but we know the timeframe will be tight. Please continue to work on these issues when CARE is again available. https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:9c771b69-784f-3fbc-a3b1-054ee1c49e64
September 13th, 2021
New TMHP Account Setup Quick Reference Guide for HCS and TxHmL Providers and FMSAs
The following providers must submit claims and forms to Texas Medicaid & Healthcare Partnership beginning March 1, 2022.
- Home and Community-based Services
- Texas Home Living
- Financial Management Services Agencies billing on behalf of Consumer Directed Services
To submit claims and forms, HCS and TxHmL providers and FMSAs must set up TMHP accounts.
The new TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide is available. The guide provides step-by-step directions to create new TMHP accounts or to link to existing accounts.
It has contact information for help and is available on the TMHP website and TMHP Learning Management System.
Read the notice posted on the long-term care homepage for more information.
September 5th, 2021
New TMHP Migration Implementation Date
A new implementation date of March 1, 2022 is planned for the release of forms and claim submissions to Texas Medicaid & Healthcare Partnership for Home and Community-based Services and Texas Home Living program providers, Local Intellectual Developmental Disability Authority agencies, and financial management services agencies that are billing on behalf of Consumer Directed Services employers.
Until the transition, HCS and TxHmL providers can continue to use the Client Assignment and Registration system for submitting claims and forms.
For more information, read the notice posted on the long-term care homepage.
July 17th, 2021
- The initial effective date of the migration (August 2, 2021) has been postponed.
- At this time HHSC is not able to estimate a new ‘effective’ date, explaining that it needs to first reach 100% compliance in its ‘testing’ phase. HHSC added that as of July 9th, it was at a 65% compliance rate, and that only 44.52% of providers have started the process (referring to registering/setting up a security account and practicing).
- HHSC is using a variety of methods to reach out to providers to remind them of the importance of preparing for this transition.
- HHSC stated there are two options from which providers can choose for claims submission – EDI or Tex Med Connect.
- According to HHSC, choosing EDI allows one to practice using the new system before the effective date.
- Though no details were provided, three (3) additional webinars will be held.
July 3rd, 2021
Migration to the TMHP LTC Online Portal – Aug. 2, 2021 Delayed
May 23rd, 2021
Migration to the TMHP LTC Online Portal – Aug. 2, 2021 Deployment (IL 2021-24)
HHSC has published IL 2021-24 1915(c) Waivers Migration to the TMHP Long-Term Care Online Portal (LTCOP) Preparing for August 2, 2021 Deployment (PDF).
HCS and TxHmL program providers and LIDDAsmust submit the following forms online through TMHP LTCOP beginning Aug. 2, 2021:
- HCS or TxHmL Pre-enrollment
- 8578 Intellectual Disability/Related Condition Assessment (ID/RC)
- 8582 TxHmL Individual Plan of Care (IPC)
- 3608 HCS Individual Plan of Care (IPC)
- HCS Provider Location Update (PLU)
- Individual Movement (IMT)
- Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments
- Request Individual Update
- Service Coordinator Update
- Initiate Individual Suspensions
- 3615 Request to Continue Suspension of Waiver Program Services
- 3616 Request for Termination of Services Provided by HCS/TxHmL Waiver Provider
Forms 8578, 8582, and 3608 with an effective date prior to Aug. 1, 2021, which are not entered into the CARE system before July 16, 2021, will require double entry by the provider or LIDDA into both CARE and TMHP systems.
Helpful Links
TMHP Portal Security Guide: https://www.tmhp.com/sites/default/files/file
library/edi/Portal Security Manual.pdf
•
TMHP EDI website: https://www.tmhp.com/topics/edi
•
TMHP EDI Agreement: https://www.tmhp.com/sites/default/files/provider-
forms/edi/F00021_EDI_Agreement.pdf
•
TMHP LTC User Guide for TMC:https://www.tmhp.com/sites/default/files/file-library/ltc/LTC_TexMedConnect_UG_092420_R.pdf
•
TMHP Provider Education/Training: https://www.tmhp.com/resources/provider-education-and-training
•
TMHP Electronic Visit Verification website: https://www.tmhp.com/topics/evv
•
HHSC HCS and TxHmL Bill Code Crosswalk:
Reminder: Avoiding HCS and TxHmL Overpayment of Services Effective Jan. 2, 2023
October 10th, 2022
Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.
On a quarterly basis, TMHP will calculate all services that have been paid through (CARE) Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount. Read the full alert.
WS&C Mailbox for HHSC To Be Discontinued As of Oct. 31st, 2022
October 10th, 2022
As part of the on-going transformation efforts, HHSC will no longer use the following mailbox, effective Oct. 31, 2022:
For a complete list of current contact information, program providers should refer to PL 2021-26 or e-mail Survey Operations at LTCRSurveyOperation@hhs.texas.gov.
For policy questions related to HCS and TxHmL, providers should e-mail LTCRPolicy@hhs.texas.gov.
IPC Renewals Submissions, Transfers, How To Submit IPC into LTCOP
Timely Submission of IPC Renewals
HHSC reminds HCS and TxHmL providers and local intellectual and developmental disability authorities (LIDDAs) to submit individual plan of care (IPC) renewals for individuals enrolled in the HCS and TxHmL waiver programs as early as program rules allow.
For HCS, renewal IPCs must be submitted at least 30, but no more than 60, calendar days before the current IPC end date.
TxHmL program providers and LIDDAs are encouraged to use the same timeframe for the submission of TxHmL renewal IPCs. Failure to do so can result in delays in processing and service authorization approval.
Important note for individuals transferring:
For a transfer involving two LIDDAs, the individual movement local authority reassignment form must be submitted and processed (status Processed/Complete or PCS Processed/Complete) prior to submission of the transfer IPC.
Guidance on HCS and TxHmL IPC submissions:
Note: There have been no changes in who is responsible for submitting IPCs since the migration of the HCS and TxHmL forms and claims from the legacy HHS Client Assignment and Registration system to the TMHP Long-Term Care Online Portal.
- For information on how to submit forms in the LTCOP portal, refer to Long-Term Care (LTC) Online Portal User Guides for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs: TMHP Learning (exceedlms.com).
Questions:
For policy questions, email your program policy inbox: HCS Policy or TxHmL Policy.
For issues encountered while submitting the IPC on the TMHP Long-Term Care Online Portal, please contact TMHP at 800-626-4117.
Related Conditions: Diagnostic Codes Updated
October 3rd, 2022
HHSC has updated the Approved Diagnostic Codes for Persons with Related Conditions effective Oct. 1, 2022 to Sept. 30, 2023.
The list of diagnostic codes has not changed for this year and can be viewed at HHSC Approved Diagnostic Codes for Persons with Related Conditions.
Important Reminder: HCS/TxHmL Webinar-October 13th, 2022
October 6th, 2022
HHSC will be hosting HCS & TxHmL Updates Provider Webinar on Oct. 13
For: HCS/TxHmL program providers, LIDDA’s, and other interested parties
This webinar will provide information on the following:
- Substantial changes being made to the HCS and TxHmL Program rules.
- IL 2022-49, assessments of HCS three-person residences, four-person residences and host home/companion care settings for compliance with the federal HCS settings rules.
HCS and TxHmL Program Updates Provider Webinar
Oct. 13
1–3 p.m.
From Our Friends at IntellectAbility: Health Risk Mitigation Tools &Training
October 6th, 2022
From our friends at IntellectAbility. Apologies, I have been meaning to post this for some of those of you who asked about this tool (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 727-437-3201 or email us at Inquiries@ReplacingRisk.com.
They can provide a demo to help you detect health risks in at-risk populations and check out their helpful video about the screening tool by clicking on link below
ANCHOR/IntellectAbility Webinars Concerning Individuals With IDD
October 6th, 2022
In partnership with ANCOR, IntellectAbility is hosting the following 2 webinars.
This webinar I believe is for all HCS Providers, not just in Texas
- October 6, 2022 at 2PM | “Leveraging Home and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) funds to Address Health Disparities for People with IDD”
Click here to register
This webinar would be helpful for all IDD Providers and Individuals with IDD and their families
- October 27, 2022 at 2PM | “Health Risk-Informed Telemedicine: A Model for Improving Health Equity for People with IDD”
Click here to register
Reminder-HCS Provider Applicants: LTC Providers Must Enroll in Texas Medicaid Before They Can Get Their Contract
August 4th, 2022
All New LTC Providers must Enroll in Texas Medicaid. (So, this means even HCS provider applicants, at least once they are nearing the stage of having their application approved and/or at the latest, prior to receiving their contract/s. Remember, you can’t start providing services and accepting clients to your HCS program until you get your letter with the approved contract/s.
- Applicants that intend to bill through TMHP for acute care or long-term care only services must enroll through TMHP.
FYI-New HCS Provider applicants, I would recommend utilizing the “walkthrough assistance” for enrollment.
TMHP offers hands-on assistance with completing and submitting the TMHP enrollment application.
For enrollment walkthrough assistance please contact the TMHP Contact Center (800-925-9126) or TMHP-CSHCN Services Program Contact Center (800-568-2413) or send an email to provider.relations@tmhp.com to request assistance with enrollment questions
Contact Administration and Provider Monitoring
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030
- PEMS provider enrollment webpage
https://www.tmhp.com/topics/provider-enrollment - TMHP Contact information
2022 IDEA (Individuals With Disabilities Education Act) Manual
October 5th, 2022
Updated 2022 IDEA Manual
The updated 2022-2023 IDEA Manual is now available in both English and Spanish on the Disability Rights Texas website.
Created in partnership with The Arc of Texas, this manual is designed to help you understand the requirements of the federal Individuals with Disabilities Education Act (IDEA) and Texas law so you can act as an equal partner in planning your child’s education.
COVID-19 Update to Temporary Change in HCS and TxHmL Policy for Service Providers of DH, Respite and CFC PAS/HAB
October 4th, 2022
COVID-19: HHSC Publishes In-Home Day Habilitation Information for Program Providers (Replaces IL 2022-48)
IL 2022-51 is posted on the HHS webpage for Home and Community-based Services, Texas Home Living, local intellectual and developmental disability authority, and financial management services agency program providers.
HHSC is temporarily waiving certain requirements in Section 3710, 4381.3, 4381.7(6) and 4381.7(7) of the HCS Billing Guidelines and TxHmL Guidelines. This is due to COVID-19 and provides access to needed day habilitation services.
HHSC has published a revision to this guidance in IL 2022-51 In-Home Day Habilitation Information for Program Providers for COVID-19 (PDF). This replaces IL 2022-48.
It extends the temporary guidance through October 31st, 2022, unless the COVID-19 public health emergency ends sooner. HHSC will provide guidance if there are any changes.
Email questions to HCS Policy.
May 30, 2022
COVID-19 Update to Temporary Change for Service Providers of Respite and CFC PAS/HAB
In March 2020, HHSC implemented a temporary policy change for respite and Community First Choice Personal Assistance Services/Habilitation. This change allows service providers of respite and CFC PAS/HAB to live in the same home as the person receiving Home and Community-based Services or Texas Home Living program services.
This change has given access to needed services for people living in their own or family’s home. A person’s spouse or a child or teenager’s parent still cannot be a paid service provider of these services due to guidelines in HCS, TxHmL and CFC handbooks located under Long-term Care Waiver Programs.
This temporary policy change is effective March 27, 2020 through October 31st, 2022, unless the COVID-19 public health emergency ends sooner. HHSC will provide guidance if anything changes. Program providers must complete the required background checks for all service providers. They must follow:
- The Texas Administrative Code, Title 40, Part 1, Subchapter D and N.
- HCS and TxHmL Rules, Section 9.177 (n) and (o), and Section 9.579 (r) and (s).
- HCS and TxHmL Billing Guidelines Section 3400 for service provider qualifications.
FYI- Don’t forget that currently (Due to COVID-19) HHSC has said if you need to add on more CFC PAS/HAB units on the IPC, you are not required to request SC to update the CFC PAS/HAB assessment. The provider needs only complete an IPC revision and IP update.
Awarded Levels for the Attendant Compensation &DCS Enhancement Programs-2023
October 2nd, 2022
Texas HHSC has posted awarded levels for Long-term Services and Supports (LTSS) providers participating in the Attendant Compensation and Direct Care Staff enhancement programs for state fiscal year (FY) 2023 for the following programs:
Attendant Compensation Rate Enhancement Program for:
- Community Living Assistance and Support Services (CLASS) – Direct Service Agency (DSA);
- Day Activity and Health Services (DAHS);
- Deaf-Blind with Multiple Disabilities Waiver (DBMD);
- Home and Community-based Services (HCBS);
- Primary Home Care (PHC);
- Residential Care (RC);
- Texas Home Living (TxHmL); and
- Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID).
To view the FY2023 enrollment awarded levels list, please visit the PFD website. If you have questions regarding your FY2023 enrollment status, please contact the LTSS Center for Information and Training (CIT) by phone at (737) 867-7817 or by email
HCS & TxHmL Webinars & FAQ’s (Recordings)
For Previously Recorded Webinars & FAQ’s
September 25th, 2022
TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar
Medicaid and CHIP Services (MCS) will begin hosting monthly meetings for Providers and Financial Management Services Agencies (FMSAs) who use the Long-Term Care (LTC) Online Portal for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs.
Texas Medicaid & Healthcare Partnership (TMHP) and Health and Human Services Commission (HHSC) staff from the following departments will be available to provide information and answer questions:
- Program Eligibility and Support (PES).
- Utilization Review (UR).
- Provider Claims Services (PCS).
- Contract Administration & Provider Monitoring (CAPM).
- Local Procedure Development and Support (LPDS).
Save the Dates
The webinars will be held on the following dates. We encourage Providers and FMSAs to invite staff who use the LTC Online Portal for HCS and TxHmL programs.
- October 2022: Wednesday, Oct. 5, 1–2 p.m. Register for the webinar.
- November 2022: Wednesday, Nov. 9, 10–11 a.m. Register for the webinar.
- December 2022: Thursday, Dec. 8, 1–2 p.m. Register for the webinar.
Standing Meeting Agenda
- Trending issues – discuss trending issues and solutions to increase successful processing of forms.
- Updates on LTC Online Portal for HCS and TxHmL – provide relevant updates.
- Questions and Answers – HCS and TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding LTC Online Portal for HCS and TxHmL.
*To comply with HIPAA requirements, questions that include any identifying information for a specific individual will not be allowed during the monthly meetings.
Email Questions to TxHmL Policy.
September 25th, 2022
HCS and TxHmL Updates Provider Webinar
HHSC will host the HCS and TxHmL Services Program Updates Provider Webinar on Oct. 13 for HCS and TxHmL program providers, local intellectual and developmental disability authorities, and other interested parties.
This webinar — offered on Thursday, Oct. 13, from 1–3 p.m. — will provide information on the substantive changes made to the HCS and TxHmL Program rules. Both webinars will provide the same information, so program providers and LIDDAs can register for the time that works best for them.
Email questions about the webinar to your program policy inbox:
September 12th, 2022
Updated HCS and TxHmL Waiver Programs FAQ Document Now Available- Sept. 2022
The Home and Community-based Services and Texas Home Living Waiver Programs Frequently Asked Questions document has been updated.
July 15th, 2022
HCS and TxHmL Webinar Recorded From July 14th, 2022
Webinar topic includes:
- Forms Submission and Processing in TMHP LTCOP
HCS and TxHmL Webinar
July 14, 2022
2:30 – 4 p.m.
Click link below to register to watch recording of this session.
Register for the webinar
Email questions about the webinar to your program policy mailbox:
July 13th, 2022
IDD and PI Quarterly Webinars
May 5th, 2022
HCS and TxHmL FAQ Updates Available May 9 and May 23
The Home and Community-based Services and Texas Home Living Waiver Programs Frequently Asked Questions document has been updated.
HCS-TxHmL-FAQ-TMHP-TexasMedConnect
Updated HCS and TxHmL COVID-19 FAQ
May 6th, 2022
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
September 1st, 2022
HHSC has revised the Updated HCS and TxHmL COVID-19 FAQ (PDF)
August 15th, 2021
HCS and TxHmL Webinar Recording Available
” WSC Transition into HHSC LTCR”
(From August 10th, 2021)
Long-term Care Regulation hosted a webinar for HCS and TxHmL program providers to discuss upcoming HHSC organizational changes, introduce LTCR survey operations leadership, and answer questions about the Waiver Survey and Certification unit’s transition into LTCR survey operations.
A recording of August 10, 2021, HCS and TxHmL Transformation Webinar with HHSC Long-Term Care Regulation is available for those who could not attend.
Read the HCS and TxHmL Transformation Webinar (PDF).
Listen to the webinar recording here.
.
May 23rd, 2021
June Infection Control Basics for HCS and TxHmL Providers Webinars
This webinar will review basic infection control concepts such as hand hygiene, standard and transmission-based precautions, and steps to prevent the spread of infectious disease.
Registration for each class is limited to 50 participants.
June 3
10 – 11:30 a.m.
Register for the June 3 webinar.
June 10
10 – 11:30 am
Register for the June 10 webinar.
June 17
10 – 11:30 a.m.
Register for the June 17 webinar.
June 24
10 – 11:30 a.m.
Register for the June 24 webinar.
.March 16th, 2021 Updated
Updated COVID-19 Frequently Asked Questions for HCS and TxHmL Providers
HHSC has published an updated Frequently Asked Questions about COVID-19 for Home and Community-based Services and Texas Home Living providers.
Read the Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
March 19 Recording of Clarification of Administrative Penalties and Related Processes Webinar Available
A recording of the March 19, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend.
Listen to the webinar recording here.
March 4 Recording of Writing Acceptable Plans of Correction Webinar Available
A recording of the March 4, 2021 Writing Acceptable Plans of Correction webinar for HCS and TxHmL program providers is available for those unable to attend.
Listen to the webinar recording here.
Feb 25. HCS & TxHmL Provider Responsibilities: Death Notifications & Investigation Reports Webinar
This webinar will provide information about program provider responsibilities for reporting abuse, neglect and exploitation and providing notifications of death.
Feb. 25
1-3 p.m.
Register for the webinar.
Jan. 5 Recording Webinar Available – HCS and TxHmL Changes to Survey Process and Hold Harmless Period Overview
A recording of the Jan. 5, 2021, HCS and TxHmL Changes to Survey Process and Hold Harmless Period Overview webinar is available for those unable to attend.
Listen to the webinar recording here.
Jan. 7 Recording of HCS and TxHmL Administrative Penalties and Amelioration Available
A recording of the Jan. 7, 2021 HCS and TxHmL Administrative Penalties and Amelioration webinar is available for those unable to attend.
Listen to the webinar recording here.
DSHS Video on Long-term Care Facilities COVID-19 Infection Prevention and Control Now Available
The Department of State Health Services has published a recorded training for long-term care providers on COVID-19 precautions to take and how to accomplish them.
October 27th IDD and PI Webinar with HHSC LTCR
September 24th, 2022
IDD & PI Webinar October 27th, 2022
HHSC Long-term Care Regulation will host a webinar for HCS, TxHmL and ICF/IID providers regarding the latest information from LTCR.
Those using Internet Explorer may have difficulties registering for the webinar. If so, try using another browser, such as Google Chrome or Microsoft Edge.
Oct. 27, 2022
10–11 a.m.
Deadline Coming Up Soon For Comments on HHSC Proposed TAC Rules
September 24th, 2022
Deadline for Comments on HHS Proposed Rules Due Oct. 17
Texas HHSC is accepting comments from stakeholders on the following proposed rules, which are now posted in the Texas Register. The comment period ends Oct. 17, 2022.
- Texas Administrative Code,
- Title 40, Part 1, Chapter 9, Subchapter N, repeal of Sections 9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, 9.583, concerning Home and Community-based Services (HCS) Program and Community First Choice (CFC); and
- Title 26, Part 1, new Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC). Comments can be emailed to HHS Rules Coordination Office.
- Texas Administrative Code,
- Title 40, Part 1, repeal of Chapter 9, Subchapter D, Sections 9.151, 9.152, 9.154 – 9.170, 9.186, 9.189 – 9.192, concerning Home and Community-based Services (HCS) Program and Community First Choice (CFC); and
- Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC). Comments can be emailed to HHS Rules Coordination Office.
Questions can be emailed to HHS Rules Coordination Office.
See TMHP’s LTC Waiver Programs Reference Material Webpage
September 18th, 2022
THMP has website page with reference material for LTC Waiver Programs. See link below:
Updated LTC Online Portal User Guides for HCS and TxHmL Waiver Programs Now Available
Updated LTC Online Portal User Guides for HCS and TxHmL Waiver Programs Now Available
The Long-term Care Online Portal User Guides for Home and Community-based Services and Texas Home Living Waiver Programs have been updated.
The learning path has been updated to include detailed instructions for entering Consumer Directed Services services in dollars instead of units, which were added to the 3608 and 8582 Individual Plan of Care Item-by-Item guides.
Crosswalk Billing Codes For DH -Sept. 2022 Update
September 17th, 2022
EVV Mismatches For DH
Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission
Concern and Issue
HCS and TxHmL providers are receiving unnecessary electronic visit verification (EVV) mismatches for Day Habilitation services due to providers not using proper bill code and modifier combinations based on where services are delivered.
Which day habilitation bill codes do I use?
In-Home Day Habilitation services delivered in an own home or family home setting require EVV visits before billing and must be billed using the following bill codes:
- M0115 – DAY HABILITATION – LN 1 – IN-HOME
- M0116 – DAY HABILITATION – LN 5 – IN-HOME
- M0117 – DAY HABILITATION – LN 6 – IN-HOME
- M0118 – DAY HABILITATION – LN 8 – IN-HOME
- M0119 – DAY HABILITATION – LN 9 – IN-HOME
- M0201 – DAY HABILITATION – LC 1 – IN-HOME
- M0202 – CDS DAY HABILITATION – LC 1 – IN-HOME – Modifier 1 Position UC
In-Home Day Habilitation delivered in a host home or companion care setting, three-person or four-person residence, and Day Habilitation provided outside of the home do not require EVV visits and must be billed using the following bill code and modifier combinations:
- M0421 – DAY HABILITATION – LN 1 – OUT-OF-HOME – Modifier 1 Position – KX
- M0422 – DAY HABILITATION – LN 5 – OUT-OF-HOME – Modifier 1 Position – KX
- M0423 – DAY HABILITATION – LN 6 – OUT-OF-HOME – Modifier 1 Position – KX
- M0424 – DAY HABILITATION – LN 8 – OUT-OF-HOME – Modifier 1 Position – KX
- M0425 – DAY HABILITATION – LN 9 – OUT-OF-HOME – Modifier 1 Position – KX
- M0460 – DAY HABILITATION – LC 1 – OUT-OF-HOME – Modifier 1 Position – KX
- M0461 – CDS DAY HABILITATION – LC 1 – OUT-OF-HOME – Modifier 1 Position – TG
September 17th, 2022
For HCS and TxHmL providers participating in the COVID add-on program, follow the instructions below.
Note: Only program providers delivering in-home Day Habilitation services in a three-person or four-person residence qualify for the COVID add-on program.
In-Home Day Habilitation services delivered in a three-person, or four-person residence do not require EVV visits and must be billed using the following bill code and modifier combinations:
- M0944 – DAY HABILITATION – LN 1 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0945 – DAY HABILITATION – LN 5 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0946 – DAY HABILITATION – LN 6 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0947 – DAY HABILITATION – LN 8 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0948 – DAY HABILITATION – LN 9 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
Resources
EVV PCS Service Bill Codes Table
HCS and TxHmL Bill Code Crosswalk (for claims with dates of service beginning 05-01-2022)
February 27th, 2022
HCS and TxHmL Billing Changes In The Crosswalk for DH
HCS and TxHmL providers must use the HCS and TxHmL Bill Code Crosswalk starting March 1, 2022 to submit claims for all services. The bill code was updated Dec. 28, 2021.
The HCS and TxHmL Bill Code Crosswalk includes new bill codes for the services that require electronic visit verification.
For HCS program providers:
- Providing out of home day habilitation or in-home day habilitation in a host home or companion care setting, program providers must use the out-of-home day habilitation bill codes.
- Not participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, program providers must use the out-of-home day habilitation bill codes.
- Participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, the program provider must use the out-of-home bill codes below with the modifiers “KX” and “CR.”
- For LON 1: M0944
- For LON 5: M0945
- For LON 8: M0947
- For LON 6: M0946
- For LON 9: M0948
Contact the HCS Policy Box with questions.
HCS Administrative Penalties, Survey, & Billing Requirement Updates
September 17th, 2022
HHSC publishes revised PL 20-55
HHSC Long-term Care Regulation updated Provider Letter 20-55 to include an updated link to the new amelioration form for HCS and TxHmL program providers.
The form is entitled 3708-A HCS and TxHmL Amelioration Request.
May 30th, 2022
HHSC has revised HCS and TxHmL Survey Operations Transformation (PL 21-26)
HHSC revised PL 2021-26 to reflect updates to the HCS or TxHmL Program Manager and Assistant Regional Director contact list.
September 5th, 2021
Now Called Billing Requirements Not Billing Guidelines!!!!
HHSC Publishes Revision 21-3 of the HCS and TxHmL Program Billing Requirements and CFC Billing Requirements
HHSC Publishes Revision 21-3 of the HCS and TxHmL Program Billing Requirements and CFC Billing Requirements
This revision, effective Sept. 1, changes the name from Billing Guidelines to Billing Requirements, and all revisions are outlined in the 21-3 Revision Section of each document.
The Billing Requirements are located on the Long-term Care Providers webpage and Handbooks webpage and are outlined below:
- HCS Billing Requirements (PDF)
- TxHmL Billing Requirements (PDF)
- CFC Billing Requirements for HCS and TxHmL Program Providers (PDF)
Email questions to TxHmL Policy.
September 5th, 2021
Very Important!!! HHSC Releases Guidance Booklet for HCS/TxHmL Providers
Section 4 of House Bill 3720, 87th Legislature, Regular Session, 2021, requires HHSC to develop guidelines for regulatory staff and providers regarding the imposition of administrative penalties. To implement this provision, HHSC is offering training to regulatory staff and providers regarding the certification principles and the administrative penalty criteria and process. In conjunction with these training opportunities, HHSC has developed a comprehensive guidance booklet (PDF) that captures the training content in a user-friendly format. This booklet is available to training participants and on the HCS and TxHmL provider portals. See the registration link below for training webinar presented on September 9th, 2021.
Register for HCS/TxHmL training here.
September 5th, 2021
HHSC Publishes Revised Informal Dispute Resolution (PL 2021-07)
HHSC published a revised version of Provider Letter 2021-07, Informal Dispute Resolution (PDF). A revision was made to update the contact phone number.
August 15th, 2021
HHSC Publishes Revised Guidance for HCS/TxHmL Providers Regarding: How to File a Survey Complaint (PL 20-21)
HHSC has updated PL 2020-01, How to File a Complaint Regarding a Surveyor and Report Survey Inconsistencies (PDF).
The letter has been revised to include information for how HCS and TxHmL program providers can file a complaint regarding a surveyor, how to report survey inconsistencies related to the interpretation and application of regulations and rules, and to provide updated contact information for Long-term Care Regulatory HCS and TxHmL regional program staff.
April 26th, 2021
HHSC’s WS&C Portal
Additional changes are coming to address Surveys and violations received from surveyors. These include contacting WSC staff concerning violations and submitting EOC’s and POC’s to WSC through the WSC Portal!
On April 27th and 29th 2021: HHSC hosted a webinar on WSC Portal Training for HCS/TxHmL providers.
- A recorded session of The WSC portal training
Here are the handouts:
- Basics of portal
- Provider letter 2021-13
- WSC Portal Training Handout
This portal will only be used to enter final PIR Reports, Submit EOC’s (Evidence of Correction), Submit POC’s (Plans of Correction) as well as communicate with WSC staff about POC’s/EOC’s, and Report a Death of an Individual in the program.
- Where do I find the page to create the portal?
- Bookmark this link below, because that is where it will be and it will go live closer to the release of the portal.
- https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/waiver-survey-certification-wsc-provider-portal
March 29th, 2021
March 19 Recording of Clarification of Administrative Penalties and Related Processes Webinar Available
A recording of the March 19, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend.
Listen to the webinar recording here.
March 28th, 2021
March 16 Recording of Clarification of Administrative Penalties and Related Processes Webinar Available
A recording of the March 16, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend.
Listen to the webinar recording here.
January 10th, 2021
Jan. 5 Recording Webinar Available – HCS and TxHmL Changes to Survey Process and “Hold Harmless Period” Overview
A recording of the Jan. 5, 2021, HCS and TxHmL Changes to Survey Process and Hold Harmless Period Overview webinar is available for those unable to attend.
Listen to the webinar recording here.
Jan. 7 Recording of HCS and TxHmL Administrative Penalties and Amelioration Available
A recording of the Jan. 7, 2021 HCS and TxHmL Administrative Penalties and Amelioration webinar is available for those unable to attend.
Listen to the webinar recording here.
December 28th, 2020
Letter: PL 20-55 Administrative Penalties HCS & TxHmL
https://apps.hhs.texas.gov/providers/communications/2020/letters/IL2020-19.pdf
December 23rd, 2020
Upcoming HCS and TXHmL Webinars For:
“Hold Harmless” Period & Administrative Penalties & Amelioration
Hold Harmless Period Overview
This webinar will cover the “Hold Harmless” period for the new survey process for HCS and TxHmL.
Jan 5, 2021
2 p.m. – 4 p.m.
Here’s the link to record session:
https://attendee.gotowebinar.com/recording/4225828217950682891
For a copy of the handouts, you can email: Shelley.Gusky01@hhs.texas.gov
Administrative Penalties and Amelioration
This webinar will review the new survey process for HCS and TxHmL which begins on March 1, 2021 and will include and overview of administrative penalties and amelioration.
Jan 7, 2021
1 p.m. – 4 p.m.
Register for the webinar.
For a link to the recording of this session and a copy of the handouts, you can email: Shelley.Gusky01@hhs.texas.gov
HHSC Publishes Administrative Penalty Process for HCS & TxHmL Program Providers (PL 20-55)
November 25, 2020
HHSC Long-term Care Regulation has published PL 20-55 – Administrative Penalty Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program Providers (PDF). The PL provides guidance to providers on the rules regarding administrative penalties.
Billing Guideline Changes
The HCS, TxHml, and CFC billing guidelines have been updated effective September 1, 2020. A summary of the revisions can be found on page 25 of the CFC (PDF), page 146 of the HCS (PDF) and page 122 of the TxHmL (PDF). Send questions about the billing guidelines to HCS.TxHml.BPR@hhsc.state.tx.us.
June 20, 2020
Survey Process: Timelines
HHSC Provider User Guide (CARE) 
Please go to the following link:
.
Updated Webinar Resource Document & TMHP Account Setup Quick Reference Guide
September 15th, 2022
Updated Webinar Resource Document and TMHP Account Setup Quick Reference Guide
(HCS and TxHmL Waiver Program Providers)
From HHSC Alert September 12th, 2022
The Webinar Resource document that accompanied the Long-Term Care (LTC) Online Portal Training for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs webinar and the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide have been updated. Read the full alert at Webinar Resource Document and TMHP Account Setup Quick Reference Guide.
Important! (Avoiding HCS and TxHmL Overpayment of Services)
September 12th, 2022
Avoiding HCS and TxHmL Overpayment of Services
Effective Jan. 2, 2023 Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.
On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount.
Read the full alert.
Revision To Billing Requirements
September 11th, 2022
HHSC Publishes Revision 22-2 of the HCS and TxHmL Program Billing Requirements, CFC Billing Requirements
Revision 22-2 is effective Sept. 1. All revisions are outlined in the Revision 22-2 Section of each document.
The Billing Requirements are located on the Long-term Care Providers webpage and Handbooks webpage and are outlined below:
- Home and Community-based Services Program Billing Requirements (PDF)
- Texas Home Living Program Billing Requirements (PDF)
- Community First Choice Billing Requirements for HCS and TxHmL Program Providers (PDF)
Email questions to TxHmL Policy.
May 8th, 2022
HHSC Publishes Revision 22-1 of the HCS and TxHmL Program Billing Requirements, CFC Billing Requirements
Revision 22-1 is effective May 2. All revisions are outlined in the Revision 22-1 Section of each document.
The Billing Requirements are located on the Long-term Care Providers webpage and Handbooks webpage and are outlined below:
PPAT Fall Conference For September 14th-16th, 2022
September 1st, 2022
Rising To The Challenge!
PPAT Fall Conference
The Association’s 25th Annual Conference is just around the corner. And, of course, a conference is not a conference without the help of many wonderful people like you and your colleagues. To ensure success we need your help. There are several ways to demonstrate your support and at the same time promote your company/agency.
They are:
Sponsoring our reception, breakfast, happy hour, and/or breaks
Advertising in the Conference Program
Marketing your services in the Exhibit Hall
Donating to the Silent Auction – all proceeds from the Auction go to PPAT’s Political Action Committee (PAC).
***We also need small items for the Goody Bags such as pens, pencils, notepads, etc.
It’s finally here, PPAT’s online registration option. Click here: REGISTRATION
Other Registration Options
If you signed up as a Sponsor, Vendor, or Registered for the Conference please contact PPAT for more information. You may contact the office at 512-452-8188.