June 5th, 2023

Form 2125 from HHSC used int the HCS and TxHmL programs as the Implementation Plan form, was updated in Oct. 2022.  The form currently has a box to check this document if consent was obtained from the individual or LAR concerning receiving services via Synchronous Audio Visual Technology .

Per standards of care, any professional therapy service or nursing service delivered using synchronous audio-visual technology must be clinically appropriate, safe, and agreed to by the individual receiving services or by the LAR. Synchronous audio-visual technology requires consent from the individual or LAR. Verbal consent is permissible and should be documented in the individual’s record. Providers must ensure that the appropriate consent box on the IP is checked.

June 5th, 2023

Just A Reminder About Consent For Synchronous Audio-Visual Technology

Revision 22-3; Effective Oct. 19, 2022

As appropriate for the individual and as permitted by service-specific requirements, the modalities for delivering services to an individual includes:

• In-person
• Synchronous audio-visual
• Audio only

In addition to meeting service requirements, providers must defer to the needs of the individual receiving services, ensuring the mode of service delivery is accessible, person-centered, and not driven by provider convenience.

Per standards of care, any professional therapy service or nursing service delivered using synchronous audio-visual technology must be clinically appropriate, safe, and agreed to by the individual receiving services or by the LAR. Synchronous audio-visual technology requires consent from the individual or LAR. Verbal consent is permissible and should be documented in the individual’s record.

****In addition:  The Providers must ensure that the appropriate consent box on the IP is checked.  (if you don’t use the IP form and you have another version, this information will have to be included as part of your IP.)

June 5th, 2023

IL 2023-22

Employment First Assessment Tool: Proposed Rules

June 5th, 2023

HHSC’s Response to Three Recent ISS-Related Questions From Providers

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

June 2nd, 2023

Critical Incident Management Reporting System (CIMS) Incident Report Submission Status

HHSC has published IL 2023-19, Critical Incident Management Reporting System Incident Report Status. This letter is an update on the form submission status of critical incident reports entered into CIMS.

This Information Letter applies to:

• Community Living Assistance and Support Services providers and case management agencies (CLASS)
• Deaf Blind with Multiple Disabilities providers (DBMD)
• Home and Community-based Services providers (HCS)
• Texas Home Living providers (TxHmL)
• Local intellectual and developmental disability authorities (LIDDAs).

Please contact MCS_CIMS@hhs.texas.gov with any questions.

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 webinar

  Email questions about the webinar to your program policy mailbox:

  • HCS Policy
  • TxHmL Policy

May 28th, 2023

When to Call the IDD Ombudsman

The IDD Ombudsman receives complaints from individuals, family members, and the general public about the care, treatment, or services provided to an individual. Individuals receiving services or family members of the individual may prefer to call the IDD Ombudsman to assist in resolving an issue rather than speaking with their LIDDA service coordinator (SC) or HCS provider.

(In addition, if you are not sure where to make a complaint or who to make a complaint to, as it may not apply specifically to a specific individual in your program, the IDD Ombudsman will generally help you find out who you need to talk to.)

A complaint may be reported to the IDD Ombudsman by anyone by calling 1-800-252-8154 between 8 a.m. and 5 p.m. Monday through Friday.

                                                                                                                  OR

Email: OmbudsmanIDD@hhsc.state.tx.us.

Online: Submit your question or complaint online

Mail: Texas Health and Human Services Commission
IDD Ombudsman
P.O. Box 13247
Austin, TX 78711-3247

Fax: 888-780-8099

.

For Your Information:  Rights Booklet and Handbook For Individuals In The HCS Program

The rights booklet, described in 40 Texas Administrative Code (TAC) §9.190(e)(2) and the rights handbook, described in 40 TAC §4.117(c) may be found on the HHSC website at https://hhs.texas.gov/about-hhs/your-rights/office-ombudsman/hhs-ombudsman-publications.

The booklet and handbook may also be obtained from HHSC by sending an email to OmbudsmanIDD@hhsc.state.tx.us.

Or click on the links below to download a copy

Resources for people with intellectual or developmental disabilities:

• Your Rights in the Home and Community-based Services Program (PDF)
• Your Rights in the Texas Home Living Program (PDF)
• Your Rights in Local Authority Services (PDF)

Resources for anyone looking for help resolving a problem concerning HHSC services:

• Have a question or problem with Texas Health and Human Services Office of the Ombudsman brochure (PDF)
• Office of the Ombudsman Reference Guide (PDF)

May 27th, 2023

 Attestation and Initial & Final Reports

May 10th, 2023

 

Check out this webinar from ANCOR. This webinar does have a registration fee.  It is open to members and non-members of ANCOR!

Wednesday, May 24, 1-2 pm EDT

“The Impact of the PHE Unwinding On Wage and Hour Compliance”

Register Today

Now that the public health emergency (PHE) has ended, providers are navigating how to unwind from emergency flexibilities and funding—both of which may have implications regarding compliance with wage and hour laws.

For example, many states included reimbursement rate increases or hazard bonuses for direct support professionals through time-limited Appendix Ks or American Rescue Plan Act funding, and the rules governing these pay increases may be viewed differently now compared to during the PHE.

Through the unwinding, it is critical that providers have a clear understanding of when to exclude and include increases from overtime pay calculations and remain in compliance when discontinuing the use of premiums.

To help you make sense of it all, this webinar will provide participants with a better understanding of the Fair Labor Standards Act, with emphasis on emerging topics from the unwinding of the PHE.

Presenters

• Lydia Dawson, J.D., Director of Policy, Regulatory and Legal Analysis, ANCOR
• Eileen Maguire, J.D., Attorney & Legal Advisor, Gilliland, Maguire & Harper, P.C.

May 15th, 2023

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 20

Since May 2, 2022, 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 & Healthcare Partnership (TMHP).

DH & ISS Billing

On March 1, 2023, day habilitation was replaced with individualized skills and socialization (ISS). To bill for day habilitation prior to March 1 and ISS after March 1, refer to the following unit information and prorating instructions.

Units:

· Day habilitation is a daily unit with a maximum of 260

· ISS is an hourly unit with a maximum of 1560

· 260 daily units of day habilitation equal 1560 hourly units of ISS

· The 1560 ISS unit maximum covers the extra day for leap year

Prorating instructions:

1. Determine how many days were used for day habilitation. (Example: 55 days used)

2. Subtract the number of days used for day habilitation from 260 (or the number of days requested) to determine the remaining days. (Example: 260 – 55 days used = 205 remaining days)

3. Multiply the remaining days by 6 (derived from dividing 1560 by 260) to determine how many hours remain to bill as ISS. (Example: 205 remaining days * 6 = 1230 ISS hours)

Other areas discussed were:

Dental Claims Units:  Providers must bill dental claims with the dollar amount as the units.

Example: If the billed amount is $100, enter “100” as the number of units.

If previous claims were paid incorrectly because the dollar amounts were not billed as units, providers can rebill correctly by performing adjustments on the paid claims. Refer to the “Adjustments” section of the Long-Term Care (LTC) User Guide for TexMedConnect for assistance.

Submitting Transfer Forms:  To avoid delays when submitting forms after transfers, the receiving providers should obtain confirmation that a transfer Individual Plan of Care (IPC) form is in Processed/Complete status before proceeding to the subsequent form

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.

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 19

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 18

January 28th, 2023

HCS and TxHmL Waiver Programs:  Trending Issue Support, Volume 17

Trending Support Issues, Vol. 17: Access to PDF R&S and 835 Electronic R&S Reports, R&S Report Information and Videos

Click on link below for full report

https://www.tmhp.com/news/2023-01-27-hcs-and-txhml-waiver-programs-trending-issue-support-volume-17

Highlights from Vol. 17

Providers are encouraged to use both the PDF version and the American National Standards Institute (ANSI) 835 electronic version of their Remittance and Status (R&S) Reports.

Providers can view and save the PDF version of their R&S Reports through TexMedConnect. The PDF files are available for 90 days following the publication date of the R&S Reports.

To access their ANSI 835 electronic R&S Reports, providers must submit an Electronic Data Interchange (EDI) Agreement and set up ANSI 835 access. In addition, providers must use an approved third-party billing software vendor from the following list. Providers can retrieve their ANSI 835 electronic R&S Reports dating back to when their submitter number was linked to their contract number.

Providers should refer to the 835 Long Term Care Companion Guide for more information about the 835 Electronic R&S Reports.

In addition:

Providers can refer to the Remittance and Status (R&S) Reports for LTC Providers Quick Reference Guide (QRG) for more information.

Additionally, a three-part educational video series is available on TMHP’s HCS and TxHmL YouTube playlist and discusses the following topics:

• General R&S Report information and instructions for account administrators on how to set permissions for users to access R&S Reports (Part 1).
• How to read and understand the first section of the R&S Report: Non-Pending Claims (Part 2).
• How to read and understand the second, third, and fourth sections of the R&S Report: Pending Claims, Financial Summary, and EOB Codes and Descriptions (Part 3).

Approved 3rd party biller list

Don’t forget our friends at Millin Billing are on this list. Contact us at info@twogetherconsulting.com for assistance with getting a demo and discount on your rate.

January 15th, 2023

HCS and TxHmL Waiver Programs:  Trending Issue Support, Volume 16

Trending Support Issues, Vol. 16:  IPC Use as a Template button and Location Code Field on Individual Movement and IPC forms

https://www.tmhp.com/news/2023-01-13-hcs-and-txhml-waiver-programs-trending-issue-support-volume-16

**When creating IPC renewals, the Use as Template button can now be used to populate form data from the original form into the new form.  This is incredibly helpful to providers now and less time-consuming.

*Another major issue that slowed down transfers I believe with LIDDA’s and also caused glitches for providers, in terms of wrong locations noted in the dropdown menu and then not being able to revise those location errors was also addressed.  See “fix” below:

Effective January 13, 2023, a text box will replace the location code drop-down box on the following IMT and IPC form fields:

· IPC transfers (3608/8582) field 39a: Receiving Program Provider Location Code

· IMTs field 18: Location Code

· IMT Individual Update fields 122: Current Location Code and 123: New Individual Location Code

· IMT LA Reassignment field 111: New Location Code

The manually entered text will be validated upon submission to ensure that the submitted location code is valid for the provider. This enhancement will improve the overall system performance related to the location code fields.

The following item-by-item (IBI) guides have been updated to reflect enhancements:

• IMT IBI
• 3608 HCS IPC IBI
• 8582 TxHmL IPC IBI

For further information, contact the TMHP LTC Help Desk at 800-626-4117. Select option 1 and then option 7.

January 12th, 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

HCS and TxHmL Waiver Programs:  Trending Issue Support, Volume 14

Trending Support Issues, Vol 14:  PEMS Revalidation and Enhancements to updating effective date of some forms  : https://www.tmhp.com/news/2022-12-30-hcs-and-txhml-waiver-programs-trending-issue-support-volume-14

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.

HCS and TxHmL Waiver Programs: Migration Trending Issue Support, Volume 11

The following is a list of common form submission statuses with descriptions and actions needed:

• Pending DADS Review
  • Description: The form is pending Texas Health and Human Services Commission (HHSC) long-term care (LTC) staff review.
  • Action: 
    • Forms 8578, 3608, and 8582: For Change LON on Existing Assessment, renewals and revisions, the submitter may need to submit a review packet to the HHSC Utilization Review (UR) department. For questions and to provide supplemental documentation, submitters can contact the HHSC UR department at 512-438-5055 or email deskURLONIPC@hhs.texas.gov.
    • 8578, 3608, 8582, and 3615 Forms: For questions and to provide supplemental documentation about enrollments, transfers, or continuation of suspensions, LIDDAs can contact HHSC Program Eligibility and Support (PES) at 512-438-2484.
    • 3616 Termination Forms: For questions and to provide supplemental documentation, providers and LIDDAs can contact HHSC Program Eligibility and Support (PES) at 512-438-2484.
• Suspensions Pending….. read more

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

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

May 15th, 2023

From HHSC

Resources on Aging

• Know Your Neighbor
• Food Security
• Nutrition at Any Age
• Understanding Nutrition
• Social Determinants of Health in Aging
• Aging: By the Numbers
• Why Age Well Live Well

May 15th, 2023

New Tool To Help Providers & Direct Support Staff/Community Attendants With Employment!

HHSC is launching Direct Care Careers Connect to help community attendants and employers connect beginning June 1, 2023.

The online platform will allow community attendants to list work history, skills, certifications, trainings, and other job qualifications. Employers will be able to post job descriptions, job specifications, and other information to help find quality candidates. Employers can also contact job candidates about posted positions.

HHSC does not play a role in the hiring process.

HHSC invites community attendants and employers to use this new online platform at no cost. Alternative terms for community attendants can include: attendant; care attendant; caregiver; direct care staff; direct service worker; direct support; home care attendant; home health aide; patient care assistant; personal care assistant; personal care attendant; special caregiver; care assistant; direct support professional; or direct care staff.

(Host Home/Companion Care Providers would seem to fall under this, but I am unclear at this time. I would contact the email below to ask.)

Email any questions to HHSCOfficeofDisabilityServicesCoordination@hhs.texas.gov.

May 15th, 2023

Recording Available of Webinar For LTC Provider Webinar on the End of Continuous Medicaid Coverage!

HHSC hosted additional live webinars in March and April of 2023, to inform providers about the end of continuous Medicaid coverage.

The webinar provided information about how long-term care providers (including nursing facilities, assisted living facilities, home and community support services agencies, Medicaid waiver providers, and intermediate care facilities for individuals with intellectual and developmental disabilities) can assist their Medicaid clients as continuous Medicaid coverage ends.

This is from the March 29 webinar. A recording is available here.

Email questions to: update@hhs.texas.gov

May 15th, 2023

Reminder for HCS and TxHmL Providers  Concerning ISS on IPC’s

HCS & TxHmL program providers, and LIDDA authorities who are submitting an Individual Plan of Care (IPC) revision to add Individualized Skills and Socialization (ISS) on the IPC plan year.

When entering IPC revisions, if you update the effective date in field 12a, you must click the search icon located next to the date field. This will allow the individual’s data to refresh and prepopulate from the web service based on the new effective date.

Contact the Texas Medicaid and Healthcare Partnership Long-Term Care Help Desk at 800-626-4117 or 800-727-5436 for assistance with submitting forms.

See links to the 2023 editions below:

May 2023 Long-Term Care (LTC) Provider Bulletin

February 2023 LTC Bulletin No. 93 (456.32 KB)

Visit the TMHP LTC homepage regularly for news, reminders, training opportunities and other important program updates.

For questions, see the LTC Provider Resources Guide.

See links to the 2022 editions below:

See link to August 2021 edition below:

The August 2021 Long-Term Care (LTC) Provider Bulletin has been published on the LTC homepage on TMHP.com.

Visit the TMHP LTC homepage regularly for news, reminders, training opportunities, and other important program updates.

For questions, see the Provider Resources section of the bulletin.

See link to February 2021 edition below:

https://www.tmhp.com/sites/default/files/file-library/ltc/bulletins/February%202021%20LTC%20Bulletin%20No.%2085_Final%20for%20Web.pdf

See link to November 2020 edition below:

https://www.tmhp.com/sites/default/files/file-library/ltc/November%202020%20Long-Term%20Care%20Provider%20Bulletin%20No.%2084.pdf

May 14th, 2023

 Guidance Related to Cooperation with HHSC Provider Investigations (PL 2023-11)

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

May 14th, 2023

May 14th, 2023

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

View the full alert here.

May 13th, 2023

Community Attendants & Direct Care/Support Workers:

Direct care/support workers & community attendants are a huge part of the Medicaid long-term services and supports system. Without these persons working with our individuals, HCS, TxHmL, CLASS, ICF and other programs would not be able to provide services. The long-term services and supports system in Texas would simply not exist without a workforce of direct care/support workers. The Texas House and Senate have passed their budgets and are now in a conference committee to finalize the ‘Texas’ budget for the state fiscal year 2024 through 2025. (Prior to this meeting the Senate ad House have not been in agreement on how much the increase of funding will be)

The Senate version of the state budget raises attendant wages by almost 40 percent. And while it is still not the $17 per hour we were initially asking for, it would still be a large increase from what providers have at this time and it would really help with staff retention and attracting more DCS/DSW workers to these programs.  Numerous Texans with disabilities rely on direct care/support workers every day.  Without these workers, many of them could not remain in their community and might end up placed in more restrictive settings like institutions such as an SSLC (State Supported Living Center).

Please take time to call:

• Senator Lois Kolkhorst (Article II): 512-463-0118, 512-463-0360
• Representative Jacey Jetton (Article II): 512-463-0710

May 13th, 2023

“The labor shortage has made it more important than ever to manage available resources effectively. Allowing existing employees to view and request open shifts can be a big help to over-stressed managers.”

Our friends at MITC have asked us to share some information on one of their very important resources, scheduling software for your shift staff in group homes and employees in general.  Please check all their info below and feel free to go to their website for more info on their other products for IDD providers and service providers.  https://mitcagencies.com/

myScheduling is just one of the tools from MITC that might be helpful to both IDD  providers (i.e. HCS, TxHmL and ICF) as well as Day Hab/ ISS (Individualized Skills and Socialization) and Supported Employment Providers

Check out some of their previously recorded videos at the links below.

Make Scheduling Easier! Let Employees Request Extra Work 01/12/23

Scheduling for Group Homes and In-Home Programs 03/02/23

How a Provider with 2,000 Employees Deployed mySchedules 04/13/23

Download These Fact Sheets:

mySchedules

Integrating mySchedules with Kronos and Other Time and Attendance Systems

Client Scheduling

Integrating Maps and Mileage into Scheduling

Encouraging Employees to Request Extra Hours

UPCOMING EVENTS & WEBINARS

“MITC’s Staff and Client Solutions are designed specifically for providers serving the I/DD and behavioral health communities.

MITC’s solutions are perfect for agencies that manage group homes, HCBS, or day, vocational, and supported employment programs!  Because we’ve worked with thousands of agencies like yours, MITC delivers the most cost-effective solutions that lead to lower payroll costs, higher performance, and compliance with state and DOL regulations.”

 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.

June 2nd, 2023

May 13th, 2023

Reminder:  EVV Claims Matching for HCS and TxHmL Will Begin for Dates of Service Starting May 1, 2023

This is a reminder that Electronic Visit Verification claims matching for Home and Community-based Services and Texas Home Living will begin on May 1, 2023. EVV claims with dates of service of May 1, 2023, and after that do not have an EVV visit match will deny.

For more information about billing updates for HCS and TxHmL, including resources to help avoid future payment denials or recoupments, reference the notice located on the EVV web page, “EVV Claims Matching for HCS and TxHmL Will Begin for Dates of Service Starting May 1, 2023”.

Email EVV Operations for questions.

April 3rd, 2023

Session 4 ORR Schedules Added to TMHP EVV Proprietary Systems Web Page

HHSC created the Session 4 Operational Readiness Review, which is a special abbreviated Electronic Visit Verification Proprietary System Operator onboarding path that supports additional PSO ORRs. This additional path allows program providers and financial management services agencies to onboard with a previously approved proprietary system or a proprietary system that is participating in the Session 3 Standard Path ORR.

The Texas Medicaid and Healthcare Partnership has updated the EVV ORR section of the EVV Proprietary Systems web page to include ORR schedules, requirements and information about the Session 4 ORR.

Email the TMHP EVV PSO inbox for questions.

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

IL-2023-03

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

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.

Email questions to TMHP.

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.

Email questions to TMHP.

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.

Email TMHP with questions.

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.

Email HHSC EVV for questions.

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:

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:
  1. The EVV visit transaction that supports the claim is accepted into the EVV Portal before claim submission.
  2. 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.

Visit the HHS EVV webpage.

HCS and TxHmL Program Providers Required to Select an EVV Vendor

11/18/2020

HCS and TxHmL Program Providers Required to Select an EVV Vendor Effective Jan. 1, HHSC will require HCS and TxHmL program providers to use EVV for the following services: Community First Choice Personal Assistance Services/Habilitation 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 Jan.1 deadlines. The requirement to select an EVV vendor and complete training applies to all contracted HCS and TxHmL program providers. Beginning Jan. 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. Read IL 20-07 (PDF) for more information about selecting an EVV vendor and completing training to be EVV-compliant by the Jan. 1 deadline.

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.

Claims Matching Policy (PDF)

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.

Email HHSC EVV for questions.

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:

1. Register for Session 1.
2. Register for Session 2.
3. 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

• Session 1 – June 9, 2020 – 8:30 am to 12:30 pm
• Session 2 – June 10, 2020 – 8:30 am to 12:30 pm

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.

For questions, contact EVV.

• •  

     EVV Proprietary System page 

    http://www.tmhp.com/Pages/EVV/EVV-Proprietary.aspx

    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:

• HHSC EVV Training webpage

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)

• TMHP EVV CBT modules 1-6.
• TMHP EVV Webinar training.

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.

May 12th, 2023

Important Reminder:  Denial of Medicaid Eligibility

HHSC has published IL2023-16 Termination of Waiver Services Due to Denial of Medicaid Eligibility.

On Dec. 29, 2022, Congress passed the 2023 Consolidated Appropriations Act, which separated continuous Medicaid coverage requirement from the Public Health Emergency declaration. The requirement for states to maintain continuous Medicaid coverage ended as of March 31, 2023. States may begin disenrolling members effective Apr. 1, 2023.

HHSC must conduct a full redetermination and allow members 30 days to respond to renewal packets or requests for information. If an individual enrolled in a waiver program is no longer eligible for Medicaid, the individual’s waiver program services will also end. This IL also includes information on how to help individuals prevent the loss of waiver services and how to monitor loss of Medicaid eligibility.

If you have questions about the termination of Medicaid eligibility, please call 2-1-1 or email update@hhs.texas.gov.

If you have questions about the termination of an individual’s CLASS, HCS, or TxHmL services, please call the IDD Program Eligibility and Support message line at (512) 438-2484.

If you have questions about the termination of an individual’s DBMD program services, please call the IDD Utilization Review message line at (512) 438-4896.

May 2nd, 2023

Infection Control Resources from HHSC

• Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF)
• Infection Control Basics & PPE Training for Essential Caregivers (PDF)
• Helping Individuals with Intellectual Disabilities and Related Conditions Prevent the Spread of COVID-19 (PDF)
• Long-term Care COVID-19 Vaccination Options (PDF)

Resources Created by HHSC

• Evidence-Based Best Practices: Infection Control is a guide for developing a facility-wide system for infection prevention and control.
• Quality Monitoring Program Immunizations web page includes information for developing a system for immunizations, as well as the current CDC guidelines for common vaccine-preventable diseases.

Center for Disease Control and Prevention (CDC)

• Infection Prevention and Control Assessment Tool for Long-term Care Facilities (ICAR) can be used by nursing facilities to evaluate their Infection Prevention and Control programs and practices.
• Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19 Pandemic) provides strategies for preventing the spread of COVID-19, as well as the latest testing and treatment recommendations.
• Nursing Homes and Assisted Living (Long-term Care Facilities) is a website for clinical professionals, residents and their families. Resources include a number of fact sheets, guidelines and toolkits that address infection control and prevention.
• Core Elements of Antibiotic Stewardship for Nursing Homes provides nursing facilities with resources for developing an effective antibiotic stewardship program.
• Influenza (Flu) is a comprehensive resource for influenza-related information.
• Hand Hygiene in Healthcare Settings provides healthcare workers and their patients with helpful information, including hand hygiene guidelines, self-assessment tools and other educational resources.
• Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit will help facilities develop interventions to prevent infections caused by CRE.

Statewide Program for Infection Control & Epidemiology (SPICE)

• Competency for Proficient Infection Preventionists can be used to document the ongoing competency of the facility’s Infection Prevention and Control coordinator/Infection Preventionist.
• Environmental Rounds Worksheet can be used to monitor environmental cleaning and infection prevention practices throughout the facility.
• Hand Hygiene Audit Tool can be used by the Infection Preventionist to monitor compliance with the facility’s hand hygiene policies and procedures.
• Hand Hygiene Competency Validation Tool can be used by the Infection Preventionist to document individual employee’s competency with hand hygiene protocols.

World Health Organization

• WHO Guidelines on Hand Hygiene in Health Care 2009 provides health care workers with evidence-based recommendations for hand hygiene in healthcare settings.
• Five Moments for Hand Hygiene is a graphic representation of the WHO Guidelines for Hand Hygiene in Health Care.

Agency For Healthcare Research & Quality

A Unit Guide To Infection Prevention for Long-Term Care Staff

National Association of County & City Health Officials  (NACCHO)

Infection Prevention and Control Resource Library  (Provides Best Practices, Tools, Teaching Materials, and specific information just for COVID-19)

May 1st, 2023

HHSC Publishes Revision 23-2 of the HCS and TxHmL Program 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:

• 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.

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.

May 1st, 2023

May 2023 HCS/TxHmL Provider Training Opportunities

Hurricane and Flooding Readiness for ICFs
Wednesday, May 3
10 a.m.–noon
Register here for webinar.

Infection Control in LTC
Thursday, May 4
6 p.m.–8 p.m.
Register here for webinar.

Individualized Skills and Socialization Basic Program Overview
Monday, May 8
11 a.m.–noon
Register here for webinar.

Hurricane and Flooding Readiness for HCS and TxHmL Providers
Wednesday, May 10
10–11:30 a.m.
Register here for webinar.

Nursing Scope of Practice in Long-Term Care Communities
Thursday, May 18
10–11:30 a.m.
Register here for webinar.

Hurricane and Flooding Readiness for HCS and TxHmL Providers
Thursday, May 18
3–4:30 p.m.
Register here for webinar.

Individualized Skills and Socialization Basic Program Overview
Monday, May 22
11 a.m.–noon
Register here for webinar.

Hurricane and Flooding Readiness for ICFs
Wednesday, May 31
2–4 p.m.
Register here for webinar.

**Writing Acceptable Plans of Correction of HCS and TxHML (course description)Texas Department of Family and Protective Services

Tuesday, May 30, 20239:00 AM – 4:00 PM
2017 N Frazier, Suite C
Room:65
Conroe, TX 77301
(24 MAX)  (Live session)  Registration    

April 2023 HCS/TxHmL Provider Training Opportunities

Most Cited Deficiencies for HCS & TxHmL Providers
Wednesday, April 12
11:30 a.m.–12:30 p.m.
Register here for webinar

Individualized Skills and Socialization Basic Program Overview
Wednesday, April 12
4–5 p.m.
Register here for webinar

Writing Acceptable Plans of Correction of HCS and TxHmL
Thursday, April 20
9 a.m.–4 p.m.
Marshall, TX
Register here for in-person class

Individualized Skills and Socialization Program Basic Overview (1 hour) (course description)

Friday, April 28, 20233:00 PM – 4:00 PM

Register here for webinar

February 2023 HCS/TxHmL Provider Training Opportunities

Infection Control Basics for HCS and TxHmL Program Providers (course description)

Wednesday, February 8, 2023 11:30 AM – 12:30 PM

Register here for webinar

Administrative Penalties and Related Processes in HCS & TxHmL Settings (course description)

Tuesday, February 28, 20231:30 PM – 2:30 PM

Register here for webinar

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.

Register here for webinar

HCS/TxHmL Program Provider Responsibilities in Death Reviews and Provider Investigating Reports

Wednesday, Dec. 211–2 p.m.

Register here for webinar

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

Register for webinar

Hurricane and Flooding Readiness for HCS/TxHmL (course description)

Wednesday, October 12, 20221:30 PM – 2:30 PM

Register for webinar

Infection Control Basics for HCS and TxHmL Program Providers (course description)

Wednesday, October 19, 20222:00 PM – 3:00 PM

Register for webinar

Emergency Preparedness 101 for HCS Program Providers (course description)

Tuesday, November 1, 20221:00 PM – 2:00 PM

Register for webinar

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:

• Joint Training website.
• HCS and TxHmL Training website.

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.

May 1st, 2023

COVID-19 Update to Temporary Change to HCS and TxHmL Policy for Respite, CFC PAS/HAB Service Provider

In March 2020, HHSC implemented a temporary policy change for respite and Community First Choice Personal Assistance Services/Habilitation provided in the Home and Community-based Services and Texas Home Living waiver programs. This change allows service providers of respite and CFC PAS/HAB to live in the same home as the person receiving these services.

This change has given greater access to needed services for people living in their own home or family’s home. A person’s spouse or the person’s parent, if the person is under 18, is not allowed to be a paid service provider of these services in accordance with the HCS, TxHmL and CFC Billing Requirements.

This temporary policy change is effective March 27, 2020, through Aug. 31, 2023. 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 26, Part 1, Chapter 263 and Chapter 262.
• HCS and TxHmL Rules, Section 9.177 (n) and (o), and Section 9.579 (r) and (s).
• The HCS Program Billing Requirements and the TxHmL Program Billing Requirements Section 3400 for service provider qualifications and the CFC Billing Requirements for HCS and TxHmL Program Providers.

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.

April 27th, 2023

In addition, see following webinar with handout

April 17th, 2023

HCS and TxHmL Town Hall Webinars and FAQs

May & June Save the Dates For Town Hall Webinar Meetings

The webinar 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.

May 2023

•  Wednesday, May 10, from 10 a.m.–noon
  Register for the webinar.

June 2023

• Wednesday, June 14, from 10 a.m.–noon
  Register for the webinar.

Standing Meeting Agenda

• Trending Issues — discuss trending issues and solutions to increase successful processing of forms.

• Training and Information Sharing — provide relevant training and updates.

• Questions and Answers — HCS/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.

Providers and FMSAs are encouraged to submit questions that they would like addressed during the webinar as part of the registration process.

April 14th, 2023

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:

1. 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 1^st 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.
2. 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 13^th.  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.
3. 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 1^st, 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

April 14th, 2023

April 12, 2023 town hall meeting

• April topics included:
  • Using the Provider Location Update (PLU) Form for moves/updates
  • Entering Individualized Skills and Socialization in TMHP
  • Highlighting Individualized Skills and Socialization Available Resources
• Questions and Answers – HCS/TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding the LTC Online Portal for HCS and TxHmL.

You can register for the recorded session at: https://register.gotowebinar.com/register/91533672855255893

PDF handout

The next meeting is May 10, 2023.  We will keep you posted on registration for this webinar.

Next session they will discuss the “Enrollment Process” and Location Code Issues

Some highlights during the April 13th, 2023 Town Hall Session: 

Use the Frequently Asked Questions document:
Frequently Asked Questions Home and Community-based Services (HCS)
Texas Home Living (TxHmL) Waiver Programs

2022 Cost Reporting:

➢WHERE: 2022 Cost Report Units of Service Information for HCS and TxHmL Programs

➢HOW: 2022 Cost Report Units of Service Tool Information for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs

➢WHO: Contact PFD-LTSS@hhs.texas.gov or (737) 867-7817, if there are questions after reviewing the above notifications

▪Refer to the HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 19 notification for updates including avoiding overbilling for service components limited to 1 unit per day, valid IMT suspension reasons for temporary discharge and billable units on IPC form accommodation for leap year.

For information on Provider Training, Webinars, Resources, and more
see:
•Texas Health and Human Services Individualized Skills and Socialization website

•Send HCS/TxHmL/DBMD Policy Individualized Skills and Socialization
Questions to: HCSPolicy@hhs.Texas.gov , TxHmLPolicy@hhs.Texas.gov ,or DBMDPolicy@hhs.Texas.gov

•Send Licensure Policy and Rules Questions to:
LTCRPolicy@hhs.Texas.gov

Things to know before billing ISS:
1) You will be authorized for 1,560 hours (max) during an IPC year.
2) Can only bill up to six hours per calendar day.
3) Can only bill five days per calendar day.  (Although you can trade out weekend days for equal amount of weekdays, i.e. Mon, Tues, Weds. Sat and Sun.)
4) Cannot date span on claims.
5) Must use HCPCS code H2014 and bill per hour.
6) Use the bill code crosswalk to see the codes and modifiers needed for the particular Individualized Skills and Socialization service.
7) Rate information can be found at this website Long term Services & Supports |Provider Finance Department (texas.gov)   Select the appropriate Service from the left side menu.

ISS Units

•Individual Skills and Socialization is an hourly unit, max 1560

•260 DH days= 1560 ISS hrs

•1560 (max) covers the extra day for Leap Year

As of January 1, 2023, you will automatically get Individualized Skills and Socialization
authorization if you were already getting day habilitation authorization.
•This information can be verified on the MESAV.
•These units for individualized skills and socialization will not be visible on the current
IPC form nor on the dashboard until a revision or renewal IPC is entered.

April 11th, 2023

**Please also check the HCS/TxHmL joint training website from HHSC, for periodic related webinars. 

Training Resources

(Videos, FAQ’s, Quick Check Guides, CBT training)

It is highly recommended that program providers, LIDDAs, and FMSAs create a TMHP Learning Management System (LMS) account at learn.tmhp.com to access current training related to the LTC Online Portal and claims submissions. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage or email TMHP Training Support for help creating an LMS account or navigating the LMS.

Suggested training resources include:

• HCS and TxHmL Waiver Programs Frequently Asked Questions
• Long-Term Care (LTC) Online Portal Basics Computer-based Training (CBT)
• TexMedConnect for Long-Term Care (LTC) Providers CBT
• Remittance and Status (R&S) Reports for LTC Providers Quick Reference Guide (QRG)
• Claim Appeals for Medicaid CBT
• TMHP Claims Video
• TMHP Account Setup for HCS and TxHmL Waiver Programs QRG
• Long-Term Care (LTC) User Guide for Online Portal Basics, General Information, and Program Resources
• Long-Term Care (LTC) User Guide for TexMedConnect

For more information, email tmhptrainingsupport@tmhp.com

April 1th, 2023

Link to HCS/TxHmL TMHP Youtube Video Playlist

April 4th, 2023

New HCBS Rules (HCS and TxHmL)

These new HCS rules have been added as TAC Title 26, Part 1, Chapter 263.

Texas Home Living HCBS regulations for compliance requirements is the following TAC title 26 part I Chapter 262

March 30th, 2023

I wanted to share the website for one of the ISS providers in the San Antonio area as they do also offer competitive employment for individuals and have employment assistance (EA) and supported employment (SE). Hope this is a good resource from some HCS/TxHmL providers in their area.

https://www.texasfoundationofhope.org/

 2845 Thousand Oaks Dr.

San Antonio, TX 78232

(210) 265-3351

txfoundationofhope@gmail.com

Office Hours:

Monday – Friday  9:00 AM to 5:00 PM

March 30th, 2023

Review of this important section in 9.174 Service Delivery

9.174  (23)  (concerning HH/CC, RSS, SL on-site expectations including locks on bedrooms and hot water temps in the home)

(23) ensure that, for an individual receiving host home/companion care, residential support, or supervised living:

(A) the individual lives in a home that is a typical residence within the community;

(B) the residence, neighborhood, and community meet the needs and choices of the individual and provide an environment that ensures the health, safety, comfort, and welfare of the individual;

  (C) there is a sufficient supply of hot water at sinks and in bathing facilities to meet the needs of individuals;

    (D) the temperature of the hot water at sinks and bathing facilities does not exceed 120 degrees Fahrenheit unless the program provider, in accordance with subsection (i) of this section, conducts a competency-based skills assessment evidencing that all individuals in the residence can independently regulate the temperature of the hot water from the sinks and bathing facilities;  (see hot water assessment form from HHSC)

(E) unless contraindications are documented with justification by the service planning team, the individual lives near family and friends and needed or desired community resources consistent with the individual’s choice, if possible;

(F) the individual or LAR is involved in planning the individual’s residential relocation, except in the case of an emergency;

(G) unless contraindications are documented with justification by the service planning team, the individual has a door lock on the inside of the individual’s bedroom door, if requested by the individual or LAR; and

(H) the door lock installed in accordance with subparagraph (G) of this paragraph:

(i) is a single-action lock;

      (ii) can be unlocked with a key from the outside of the door by the program provider; and

      (iii) is not purchased and installed at the individual’s or LAR’s expense;

March 30th, 2023

Service Delivery Logs for Individualized Skills and Socialization

March 1st, 2023

ISS Service Delivery Logs (SDL’s) & Electronic Health Record (EHR) systems

February 21st, 2023

Service Delivery Logs Finally Available for Individualized Socialization Skills Services

March 29th, 2023

 Heightened Scrutiny Process For ISS (Individualized Skills and Socialization)

Individualized skills and socialization has replaced day habilitation in these programs: HCS, TxHmL & DBMD. Individualized skills and socialization will include an on-site component and an off-site component.

The heightened scrutiny process will be required if a setting in which on-site individualized skills and socialization is provided:

(1) is located in a building in which a state supported living center or a certified intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) operated by a LIDDA is located but is distinct from the state supported living center or the certified ICF/IID operated by a LIDDA;

(2) is located in a building that is on the grounds of or immediately adjacent to a state supported living center or a certified ICF/IID operated by a LIDDA;

(3) is located in a building in which a licensed private ICF/IID, a hospital, a nursing facility, or other institution is located but is distinct from the ICF/IID, hospital, nursing facility, or other institution;

(4) is located in a building that is on the grounds of or immediately adjacent to a hospital, a nursing facility, or other institution except for a licensed private ICF/IID; or

(5) has the effect of isolating individuals from the broader community of persons not receiving Medicaid HCBS.

If heightened scrutiny is required, a provider must complete the heightened scrutiny process and receive written approval from HHSC before submitting an application to become licensed as a day activity and health services facility with a special designation for individualized skills and socialization.

Read more about the heightened scrutiny process for individualized skills and socialization in Information Letter 22-53, Requirements for Providers Seeking to Deliver New Individualized Skills and Socialization Services (PDF).

Questions

If you have questions about the heightened scrutiny process or whether it applies to you, email MCS_Heightened_Scrutiny_Review@hhs.texas.gov.

March 28th, 2023

Host Home Companion Care Providers Concerning ISS & PHE Flexibilities For In-Home ISS

Clarification Concerning Information Letter No. 2023-10 (Replaces IL 2023-06) from February 2023
In-Home Individualized Skills and Socialization Information for Program Providers for COVID-19 PHE

In response to COVID-19 and to provide access to day habilitation services, the Health and Human Services Commission (HHSC) temporarily waived certain requirements in Sections 3710, 4381.3, 4381.7(6) and 4381.7(7) of the HCS Billing Requirements and the TxHmL Billing Requirements. Until the end of the COVID-19 PHE, this flexibility will continue as part of in-home individualized skills and socialization.

Effective May 12, 2023, these flexibilities will no longer be in effect:

The flexibility has allowed HCS and TxHmL program providers to provide in-home individualized skills and socialization to an individual in the individual’s residence, including those residing in their own homes or family homes, without having the required justification outlined below. Program providers and LIDDAs need to have transition plans ready for individuals who receive in-home individualized skills and socialization prior to this end date (before May 12th, 2023).

Beginning May 12th, 2023:

in order to receive in-home individualized skills and socialization, individuals must meet all requirements outlined in the HCS and TxHmL Program Rules, the HCS Billing Requirements, and the TxHmL Billing Requirements, which include:
• A physician has documented that the individual’s medical condition justifies the provision of in-home individualized skills and socialization; or
• A licensed professional or behavioral support service provider has documented that the individual’s behavioral issues justify the provision of in-home individualized skills and socialization; or
• The individual is 55 years of age or older and requests to receive in-home individualized skills and socialization.
In addition, after May 11, 2023, a service provider of host home/companion care will not be permitted to provide in-home individualized skills and socialization to the individual to whom they provide host home/companion care services.

Clarification & Answer to Question From Some of Our Readers: 

This letter indicates that HHSC does not appear to prevent a host home provider from becoming an ISS provider, nor does it prevent that licensed ISS provider from providing on-site and/or off-site services to their own individuals living with them.  In other words, it would appear they can be a HH/CC provider and licensed ISS provider at the same time and they can provide ISS services to their own individuals they are serving as HH/CC providers.   They can not provide their own in-home ISS (anymore) as an HH/CC provider as of May 12th, 2023.  The only ISS they can provide after May 11th, is if they are a licensed on-site and/or off-site provider.

March 1st, 2023

Reminder Must Be Licensed As ISS Provider To Bill As Of March 1st, 2023

For HCS/TxHmL Providers, you can’t bill for On-site &/or Off-site ISS as of today March 1st, 2023, if you send someone to an ISS location or have staff providing Off-site services (previously Community DH), if they are not listed as a licensed ISS program. 

The directories may be accessed at:  https://www.hhs.texas.gov/providers/long-term-care-providers/day-activity-health-services-dahs  to find out if the ISS program is licensed.

**You can bill for In-Home ISS as persons providing In-Home ISS do not have to be licensed!  No justification is needed for In-Home through May 11th, 2023 I believe. I believe HH/CC providers can still provide In-Home (This was part of the PHE exception prior to March 1st) up through May 11th, 2023, but I am still unclear and will inquire and update everyone when I get some kind of definitive answer.

Previous DH providers & New ISS Provider applicants: If you do not have a temporary ISS license by March 1, 2023, you may not provide or bill HCS, TxHmL, or DBMD providers for on- and off-site ISS services until the temporary license is received.  HCS/TxHmL, DBMD Providers who have individuals attending an ISS program may not send persons to the program until they confirm that the operator of the program has received the license.  There are no exceptions.

February 21st, 2023

 Very Important:  Surveys of ISS Providers With Temporary Licenses

In case this information was overlooked by new ISS providers:

• Once HHSC issues a temporary license, HHSC may conduct a survey at any time.
• HHSC may conduct a survey of any licensed Individualized Skills and Socialization Providers prior to March 1, 2023.
  • i.e. if HHSC issues a temporary license on Feb. 21, 2023, HHSC may conduct an initial survey on Feb. 27, 2023.
• HHSC conducts unannounced surveys of ISS Providers.
• For on-site ISS providers, the address on the license must match the address for service provision.
• ISS providers must allow HHSC surveyors access to the on-site location and off-site activity locations.

Please refer to Texas Administrative Code Title 26, Chapter 559 for more info on the LTCR survey process.

February 10th, 2023

How Do I Find A Licensed ISS Provider?

HHSC has now posted directories on the DAHS webpage to help people find a licensed ISS Provider.

The directories may be accessed at:  https://www.hhs.texas.gov/providers/long-term-care-providers/day-activity-health-services-dahs

Please note the following:

• There are 2 directories:  DAHS with ISS and DAHS-ISS Only.
• The DAHS with ISS Directory is intended to reflect entities licensed as just a DAHS, and entities licensed as DAHS with ISS.
  • At this time, this particular directory lists all entities as just having a DAHS license. This is because the commission has yet to approve any DAHS with ISS licenses.  The process for approving a DAHS with ISS application takes longer than that of a provider applying as an ISS-only entity.  According to HHSC, the entity must undergo an LSC and Health survey before a license is issued to a DAHS with ISS entity.  Once these have been approved, they will be listed in this directory as DAHS with ISS.
• Entities listed in the DAHS – ISS Only Directory, currently reflect a 6-month license.  This is because these licenses are considered ‘temporary’ at this time. Once the health survey is conducted the entities will receive a one, two or three-year license. 

February 5th, 2023

HHSC LTCR Updates the ISS FAQ’s

HHSC Long-term Care Regulation updated the Individualized Skills and Socialization frequently asked questions document on Feb. 01, 2023.

Read the FAQ here.

January 27th, 2023

FYI- somehow I missed this alert back in November for Licensed ISS providers.  Please be sure to log in and set up your account.

PL 22-32 letter issued 11/28/22 to ISS providers that was sent out concerning Blackboard Connect Emergency System

The purpose of this letter was to inform providers of the emergency communication system called Blackboard Connect, how it will be used, and your responsibility in signing up for the system if you are an ISS provider. This system will be used to send emergency and outreach notifications through email, phone, voice and text if available.

The rules require program providers to assign a designee to enroll in and respond to requests through the system. The designee should be someone who is associated with the licensed building or someone who is responsible for communicating emergency communications. However, you may also have other designees, such as corporate headquarters staff, sign up.

Blackboard Connect sign-up process:

Go to this link and click “Sign Me Up!”

If you have any questions, please contact the Policy and Rules Section by email at LTCRPolicy@hhs.texas.gov or call (512) 438-3161.

Rember, this also applies to HCS, TxHmL and ICF providers among other services.

January 16th, 2023

• The ‘new’ IPC referenced in IL 2022-03 will most likely not be ready until March.  They did not have answers as to what providers should do in the interim or even how service logs should be revised until new ones are available. (The letter does indicate that those individuals receiving DH at the time of the switch to ISS (March 1st, 2023) will initially roll over automatically to ISS ).
• After Feb. 28th this would apply to all current clients as far as IPC units are concerned. Persons who don’t have any Day Hab units/days on their plan as of Feb. 28th, 2023 and want ISS hours, will have to do a new PDP and request IPC hours.   Providers will have a new IPC form, with ISS on it, before March 1st, 2023.
• To date, no provider has been issued an ISS license.
• Providers can confirm that an entity has an ISS license by checking the DAHS directory on the DAHS webpage:   https://www.hhs.texas.gov/providers/long-term-care-providers/day-activity-health-services-dahs

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

IL-2023-03

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

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

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

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

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.
  • July 2022 – Individualized Skills and Socialization Webinar (PDF)

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:

March 26th, 2023

HHSC published PL 2023-06 Compliance with New HCBS Settings Rules

HHSC Long-term Care Regulation published Provider Letter 2023-06 regarding Compliance with New HCBS Settings Rules on March 24, 2023. This letter explains how LTCR surveyors will assess HCS providers for compliance with the new HCBS settings requirements.

March 15th, 2023

The Center for Medicaid and CHIP Services (CMCS) is sharing this toolkit with State Medicaid Agencies, Operating Agencies, and other stakeholders a Home and Community-Based Settings Toolkit to assist states to develop Home and Community-Based 1915(c) waiver and 1915(i) SPA amendment or renewal application(s) to comply with new requirements.

Texas State Transition Plan for CMS’s HCBS Compliance Requirements (2022 update)

These requirements were noted in the recently published Home and Community-Based Settings (HCBS) regulations.  HHSC is amending TAC rules to add requirements for all settings in the HCS program, including 3-person and 4-person group homes and host home/companion care settings, to comply with HCBS settings requirements at 42 CFR §441.301(c)(4)(i)-(v).

These new HCS rules have been added as TAC Title 26, Part 1, Chapter 263.

Texas Home Living HCBS regulations for compliance requirements is the following TAC title 26 part I Chapter 262

I would pay attention, in particular to the following information in the toolkit:  Info on residential & non-residential settings, Q&A for HCBS, Transition Plan toolkit, and the info on Heightened Scrutiny and the Review process for it, as well as person-centered requirements.  

Handy Dandy List of Items In The Toolkit:

• SMDL: Home and Community-Based Settings Regulation – Implementation Timeline Extension and Revised Frequently Asked Questions – July 14, 2020
• March 2019 Updated Frequently Asked Questions on Heightened Scrutiny Provisions
• July 2019 CIB: Heightened Scrutiny Review of Newly Constructed Presumptively Institutional Settings
• All State Call Slides: FAQs on Heightened Scrutiny – March 2019
• FAQs concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior
• A summary of the regulatory requirements of fully compliant HCB settings and those settings that are excluded.
• Schematic drawings of the heightened scrutiny process as a part of the regular waiver life cycle and the HCBS 1915(c) compliance flowchart.
• Additional technical guidance on regulatory language regarding settings that isolate.
• Exploratory questions that may assist states in the assessment of:
  • Residential Settings
  • Non-Residential Settings
• Questions and Answers Regarding Home and Community-Based Settings
• Statewide Transition Plan Toolkit for Alignment with HCB Settings Regulation Requirements Suggestions for alternative approaches and considerations for states as they prepare and submit Statewide Transition Plans for the new federal requirements for residential and non-residential home and community-based settings. The regulatory requirements can be found at 42 CFR 441.301(c)(4)(5) and 441.710(a)(1)(2).
• Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information
• Frequently Asked Questions on Planned Construction and Person-Centered Planning Requirements

REQUEST TECHNICAL ASSISTANCE WITH HCBS SETTINGS CRITERIA

March 20th, 2023

​88th Legislative Session in Texas!

Here Are A Few House Bills Submitted That May Affect Long-Term Care & Other Services For Persons With Disabilities

• HB 54: Personal needs allowance for certain Medicaid recipients who are residents of long-term care facilities.

• HB 144: Possible Exemption from ad valorem taxation of the total appraised value of the residence homestead of an unpaid caregiver of an individual.

• HB 166: The appointment of an educational representative for certain students with disabilities.

• HB 245: Community attendants under the community attendant services program.

• HB 568: Education and training for peace officers on interacting with persons with Alzheimer’s disease and other dementias.

• HB 653: Guardianships of the person of wards with profound intellectual disabilities who are minors or were minors when their guardianship proceedings commenced.

• HB 1430: Establishing a minimum wage for certain personal attendants under Medicaid and other programs administered by HHSC  (One can only hope this means an increase in funding for wages!)

• HB 1593: Infection prevention and control programs and other measures for communicable diseases at certain long-term care facilities.

See more info on House Bills and Senate Bills in the PDF links below.

Feb 2023 HB’s

Feb 2023 SB’s

March 2023 HB’s

March 2023 SB’s 

*Note:  Each bill provides a link to the text of the bill.  After clicking on the link, click on ‘text’.  Under ‘Text’ you will find the bill as filed and various versions of the bill as it makes its way through the committee process and moves from one chamber to the other. Bills highlighted in yellow are deemed ‘priority’ bills. 

March 5th, 2023

Thanks to our friends at ARC for posting this in one of their recent newsletters

1915(c) Waiver Interest Lists by Legislative District

Find below maps produced by The Arc of Texas showing how many Texans on Medicaid waiver interest lists live within each State House, State Senate, and Congressional district. The Medicaid waivers being tracked are all CLASS, DBMD, HVC, MDCP, STAR+ PLUS, and TXHML.

The darker the hue of the district, the more people there are on any interest list in that district.

Each district’s label indicated the current incumbent in that district.

Clicking on each district with show more detailed information.

• State House
• State Senate
• Congress

February 27th, 2023

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

Under Chapter 263, Subchapter F related to Provider Owned or Controlled Residential Settings, in particular Sections 263.501, 263.510 and 263.503.  The rules under these sections address the following:  requirements related to HCBS settings (Section 263.501); requirements as to what providers must ensure in the delivery of services, such as privacy in bedrooms, an operable bedroom door lock, access to food, choice of roommates, etc. (Section 263.502); and requirements related to residential lease agreements (Section 263.503).

February 23rd, 2023

Check Out This Info From Milling Billing Pro.

See the following Vimeo Videos.  If you need billing software or billing services for TMHP and EVV this may be a great option for Texas HCS & TxHmL providers.  They are also ready for the change over to ISS (Individualized Socialization Skills) when March 1st, 2023 comes around.  To request a demo from Millin Billing please go to  Request A Demo

Remember to tell them how you heard about Millin Billing Pro (Twogether Consulting) for a discounted rate.

Millin Billing Pro Video

Management System video from Millin Billing

February 25th, 2023

February 22nd, 2023

I know providers have really been concerned about the period of time between March 1st and May 11th while the PHE has been extended, as to whether or not this will include ISS services for In-Home ISS.

HHSC stated it would release a notice soon stating that beginning March 1, 2023 in-home ISS can be done without the justification (medical or behavioral justification or anyone 55 years of age and older should they request such) for such that will be required in the rules, through May 11th.  After May 11th, however, this will not be permitted anymore and the justifications for in-home ISS must be in place.

***Remember medical and behavioral justifications will require medical recommendations or orders from physician and/or behavioral support professional recommendations (i.e. psychologist, bcba)

February 22nd, 2023

 In-Home ISS in HH/CC Settings:  If persons receiving HH/CC services receive in-home ISS only, the provider does not have to be licensed.  If the person receiving HH/CC services engages in community activities (known as off-site ISS), then the provider of the off-site ISS must be a licensed ISS provider.

February 21st, 2023

Update on Who Qualifies To Assess The Need For A Modification

According to HHSC (and the proposed rules that will now be under Chapter 263) modifications to the door lock requirement must be based on a documented, assessed need and brought to the SPT for review and documentation in one’s PDP

As to whom determines the assessed need, HHSC stated at recent training sessions in Lake Jackson and Austin I believe, that a licensed professional, defining such as a doctor, RN, behavioral health provider, or other therapist providing such determination is within the scope of their practice.

February 14, 2023

Protocol For Modifications to AccessTo Food, Locks on Individual’s Doors & Other CMS Regs HCBS Settings Rules

Please see the alert letter below for complete information discussed in this post:

IL-2023-05

“In 2014, CMS issued federal regulations for settings where Medicaid home and community-based services (HCBS) are provided. All settings where Medicaid HCBS are delivered must meet federal requirements by March 17, 2023.

HHSC is finalizing updates to the HCS Program rules at 26 TAC §263.502. The rules are expected to be adopted in early 2023 and will include the detailed requirements outlined below.
The federal regulations require that all individuals residing in a provider-owned or controlled setting must ensure certain requirements are met. These requirements include:

● Individual privacy in the bedroom;
● Choice not to share a bedroom;
● Choice of roommate if sharing a bedroom;
● A lock is installed on the bedroom door;
● Individual can furnish and decorate their bedroom;
● Individual has control over their schedule and activities that are not part of an implementation plan;
● Individual has access to food at any time;
● Individual has the ability to have visitors of their choosing at any time;

If a program provider becomes aware that a modification to one of these requirements must be implemented due to a specific assessed need of an individual, the program provider must notify the service coordinator as soon as possible. The program provider must provide the service coordinator with the following information:

● A description of the specific and individualized assessed need that justifies the modification;
● A description of the positive interventions and supports that were tried but did not work;
● A description of the less intrusive methods of meeting the need that were tried but did not work;
● A description of the condition that is directly proportionate to the specific assessed need;
● A description of how data will be routinely collected and reviewed to measure the ongoing effectiveness of the modification;
● The established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;
● The individual’s or legally authorized representative’s (LAR’s) signature evidencing informed consent to the modification; and
● The program provider’s assurance that the modification will cause no harm to the individual.

If the service coordinator receives a notification from the program provider of a required modification(s), the service coordinator must convene a service planning team (SPT) meeting to update the person-directed plan (PDP) with the information above.

If the SPT agrees to the modification(s) and updates the PDP, then the program provider may implement the modification(s).

**Note that a family member/LAR’s request or preference to not comply with one of the requirements is not considered an individualized assessed need that justifies a modification to the federal requirement.”

Link to PowerPoint Handout From Austin Training on February 10th, 2023 for information discussed on this subject and other current issues (residential agreements, ISS, etc…)

February 14th, 2023

Repeal of HCS Rules under Title 40, Chapter 9 / Movement to Title 26, Chapter 565

February 10th, 2023

From HHSC’s PAT  FAQ’s as of Jan. 1st, 2023

“Frequently Asked Questions for Providers Applicant Training (PAT) for HCS/TXHML”

-When is the Provider Applicant Training (PAT) Online available?
This training is now available online. The PAT training is the first step for applicants to obtain a contract with HHSC. Please do not submit your application without the PAT certificate that reflects a passing score of 85% or above.

-Who can take the training?
Applicants listed on Form 3681, Section 8.a and 8.b must complete the online PAT training. The Program Manager listed must complete the training and pass the test with an 85% or above.
See Texas Administrative Code Title 40, Chapter 49, Rule §49.204.

-How can I access the HHS Learning Portal?
• HHS Learning Portal (texas.gov).
• Set up your new account. You will need to confirm your new account through the email address used.
• Find and select the Medicaid Long Term Services and Support Training under “Course Categories.”
• Select the Provider Applicant Training (PAT) link. Select “Enroll me” to access the Training and get access to the “Welcome” page.

The training is compiled in four different steps.

Step 1. Important to know Before you Get Started
 Fill out the Provider Applicant Training (PAT) Information form. This form must be completed to access the introduction and the training modules.

Step 2. Training Modules
 Complete each module must be completed to advance to the next module.

Step 3. Evaluation and Certificates
 Complete the mandatory survey

Step 4. Provider Competency Exam
 Download, and save your exam certificate upon completion. Submit the certificate along with your completed application

PAT FAQ’s read more

IMPORTANT:  You must take the PAT before you can apply to be an HCS Provider!!!.  You must pass the Test by 85 %  If you fail the test, you can’t retake the test for a period of 6 months, so please study the TAC before and pay careful attention to the PAT modules before answering test questions.

Note: If you do not pass on your first attempt, please DO NOT apply.

March 2nd, 2023

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

February 9th, 2023

The Biden administration plans to end the state of Public Health Emergency (PHE), due to the pandemic.  Many are warning that the shift will have major implications for people with disabilities that go far beyond COVID-19.

Under the public health emergency, which has been in place since 2020, states have been eligible for extra federal funding for Medicaid in exchange for agreeing not to drop most beneficiaries from the program. The federal government has also given HCS providers added flexibilities during this time.

Currently, it appears that President Biden plans to extend the public health emergency to May 11, at which point it will end.

I can’t stress enough, that people with disabilities and their families (or specific Medicaid contact person) make sure they respond to any mail or email from their Medicaid office, that their address is up to date at HHSC & Medicaid as well as being in compliance with the financial eligibility rules under Medicaid as well.  Be sure to fill out any annual Medicaid Status Reports on time as well.

If an IDD provider (HCS, TxHmL, etc..) is the contact person for Medicaid please have all available persons that are appropriate assist with this process to ensure your individuals do not lose their Medicaid. ( i.e. case managers/care coordinators, program managers, financial dept. staff, etc.) 

States can start the redetermination process as soon as this month and can terminate Medicaid coverage for individuals as early as April 1. Across the country, the process is expected to be complete no later than May 2024.

February 9th, 2023

Where can you find helpful Training Videos on the PEMS process? Check out the TMHP page with their Youtube videos for PEMS.

In addition, you will find information on removing TPI’s and a Video series on running and utilizing your R&S Reports

1915 (c) waiver page at TMHP For YouTube Training Videos

Specific link to R&S Report Video Series

Specific link to Removal of TPI From Forms Video

For Previously Recorded Webinars & FAQ’s

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/hcs-txhml-webinars-faqs

February 5th, 2023

IDD and PI Quarterly Webinar with HHSC LTCR Recording Available

The January 26 recording of the Intellectual and Developmental Disability (IDD) Programs and Provider Investigations (PI) Quarterly Webinar with Long-term Care Regulation (LTCR) is available.

Listen to the webinar recording.

Read the IDD and PI Webinar (PDF).

Any questions or requests for transcripts may be emailed to LTCR Policy.

November 1st, 2022

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.

• Register now for the Oct. 13 webinar.

Email questions about the webinar to your program policy inbox:

HCS Policy

TxHmL Policy

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.

Read the full alert.

July 15th, 2022

HCS and TxHmL Webinar Recorded From July 14th, 2022

July 13th, 2022

IDD and PI Quarterly Webinars

• July 12, 2022 IDD and PI Quarterly Webinar (PDF)
  • July 12, 2022 IDD and PI Quarterly Webinar Recording

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

Read the full alert here.

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.

View the video training

February 5th, 2023

Proposed HCS and TxHmL Billing Requirements

February 5th, 2023

LTC Provider Bulletin Now Available

The February 2022 Long-Term Care (LTC) Provider Bulletin has been published on the LTC homepage on TMHP.com.

Visit the TMHP LTC homepage regularly for news, reminders, training opportunities, and other important program updates.

For questions, see the LTC Provider Resources Guide under Reference Material.

January 5th, 2023

IMT and IPC Form Enhancements and IBI Guide Updates Now Available

January 31st, 2023

Advocacy Toolkit from our friends at the ARC of Texas

https://www.thearcoftexas.org/wp-content/uploads/Advocacy-Toolkit.pdf

Common Nursing Violations:  Prevention & Correction 

February 23rd, 2023 10 AM-12:00 PM

(ICF/IID)

The HCS/TxHmL Interpretive Guidance Booklet: Nursing Focus

February 27th, 2023 11AM-12:30 PM

(HCS/TxHmL)

March 2023

Billing Requirement Changes In HCS-2023 Update 

March 29th, 2023  10AM-12:30PM

To Be Determined At A Later Date

Abuse, Neglect & Exploitation Allegation Follow-Up Requirements: (HCS/TxHmL Providers)

(This session is for:  Administrative Staff, Program Managers, Case Managers/Care Coordinators, Nurses, and Quality Assurance Staff)

Abuse, Neglect & Exploitation Allegation Follow-Up Requirements: (ICF/IID Providers)

(This session is for: Administrators, QIDPs, House Managers, Nurses, and Quality Assurance Staff)

Pre-recorded sessions are available for purchase!

To Purchase these Pre-Recorded Trainings:

Go to www.twogetherconsulting.com

Or

Contact us at Javasbja@gmail.com at Meghanjones.tx@gmail.com

Currently, we have the following pre-recorded sessions:

HCSTxHmL Pre-Recorded Webinar Sessions

Expectations of The Nurse: HCS/TxHmL

(includes: Delegation, CNA Training, Billable Services & Documentation as well) (4 Part Series)

Care Coordination (5 Part Series)

CARE COORDINATION  (5 Part Series)

Part I  

“Roles & Responsibilities: The LIDDA Vs. The Provider (For HCS/TxHmL providers)

Contact us at info@twogetherconsulting.com to purchase this training and the handouts.

Part II   Pre-recorded sessions available for purchase!

“Important Parts of The TAC In Relation To The HCS Handbook”  (For HCS/TxHmL providers)

Part III   Pre-recorded sessions available for purchase!

For HCS & TxHML Providers

“Developing The IP Using Person-Centered Practices” This is part 3 of 5 of our Care Coordination series.

Part IV   Pre-recorded sessions are available for purchase!

“ICAP/IDRC/LON” Webinar  This is part 3 of 5 of our Care Coordination series.

Part V  Pre-recorded sessions are available for purchase!

(Billable Services- HCS)    This session is split up into 2 parts!  Each section is 2 to 2.5 hrs long

General Billable Services (Day 1) & then Adaptive Aids/Minor Home Mods/Dental (Day 2)

Contact us at info@twogetherconsulting.com to purchase this training and the handouts.

January 27th, 2023

As of 1/27/23, there have been no new alert letters concerning the extension of temporarily waiving certain requirements for In-Home DH  due to the Public Health Emergency, past  January 31st, 2023. This was the date we were given in Letter No. 2022-55.

My understanding is providers would receive notice at least 30 days prior to ending the PHE.  I am assuming at this time that the PHE will extend through Feb. 28th, 2023.  In-Home DH billing will discontinue in TMHP as of March 1st, 2023, so the last day to bill In-Home DH will be Feb. 28th, 2023.  At this point, we move to In-Home ISS services. However, if the PHE does not end, I am unclear yet if In-Home ISS will allow for continuing to waive certain requirements temporarily due to the PHE.  I believe that due to the fact the allowance for anyone to qualify for In-Home DH during the PHE is not part of the In-Home ISS rules/ISS rules, that an addendum would have to be put in place to cover In-Home ISS due to PHE.  Not sure that will happen, so I would plan to be ready by March 1st.

Otherwise, come March 1st, 2023 all individuals wishing to receive In-Home ISS services will have to qualify in the following way:

In-home ISS must be provided in the individual’s residence.

Billing Requirements Section 49102.3

Requirement for Justification by a Licensed Professional or to be 55 Years or Age or Older
Revision 23-1; Effective January 1, 2023

An individual may receive in-home individualized skills and socialization only if:

(a) a physician has documented that the individual’s medical condition justifies the provision of in-home individualized skills and socialization; or

(b) a licensed professional or behavioral supports service provider listed in Section 4240(2), Qualified Service Provider, has documented that the individual’s behavioral issues justify the provision of in-home individualized skills and socialization; or

(c) the individual is 55 years of age or older and requests to receive in-home individualized skills and socialization.

In addition, EVV will need to occur for In-Home ISS services.

Qualifications for Service providers of In-Home ISS are as follows (they don’t need to be licensed)

49102.8 Qualified Service Provider

Revision 23-1; Effective January 1, 2023

In addition to meeting the requirements in Section 3400, Qualified Service Provider, a qualified service provider of the in-home individualized skills and socialization service component;

• (a) must have: (1) one of the following:
• (A) a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma; or
• (B) documentation of a proficiency evaluation of experience and competence to perform the job tasks that includes:
• • (i) a written competency-based assessment of the ability to document service delivery and observations of the individuals to be served; and
  • (ii) at least three written personal references from persons not related by blood that indicate the ability to provide a safe, healthy environment for the individuals being served; and

  (b) must not be the individual’s host home/companion care service provider

November 21, 2022

Letter No. 2022-55 (Replaces IL 2022-54)

This information letter (IL) replacesd IL 2022-54 In-Home Day Habilitation Information for Program Providers for COVID-19, previously released on October 31, 2022, to extend the temporary guidance through January 31, 2023, unless the COVID public health emergency ends sooner. HHSC will provide guidance if anything changes.
In response to COVID-19 and to provide access to needed day habilitation services, the Health and Human Services Commission (HHSC) is temporarily waiving certain requirements in Sections 4381.3, 3710, 4381.7(6) and 4381.7(7) of the HCS Billing Guidelines and the TxHmL Billing Guidelines.

Effective March 13, 2020, through January 31, 2023 unless the COVID PHE ends sooner:
● HCS or TxHmL program providers may provide day habilitation to an individual in the individual’s permanent or temporary residence without having the justification required by Section 4381.3. This includes individuals residing in their own homes or family homes.

For more info, please click on the information letter.

January 27th, 2023

HHSC Form Required for Fire Drills for ISS Providers

Click on link below

Form 4719

* Some providers have noted that this form seems a bit inappropriate for ISS providers as the form has locations that seem more appropriate for a “home” setting, as opposed to maybe a “building” used by a licensed ISS provider, but it does have a box for “other” locations.

January 26th, 2023

FYI- somehow I missed this alert back in November for Licensed ISS providers.  Please be sure to log in and set up your account.

PL 22-32 letter issued 11/28/22 to ISS providers that was sent out concerning Blackboard Connect Emergency System

(This applies to HCS, TxHmL, ICF, & DAHS-ISS Providers among other services)

The purpose of this letter was to inform providers of the emergency communication system called Blackboard Connect, how it will be used, and your responsibility in signing up for the system if you are an ISS provider. This system will be used to send emergency and outreach notifications through email, phone, voice and text if available.

The rules require program providers to assign a designee to enroll in and respond to requests through the system. The designee should be someone who is associated with the licensed building or someone who is responsible for communicating emergency communications. However, you may also have other designees, such as corporate headquarters staff, sign up.

Blackboard Connect sign-up process:

Go to this link and click “Sign Me Up!”

If you have any questions, please contact the Policy and Rules Section by email at LTCRPolicy@hhs.texas.gov or call (512) 438-3161.

January 16th, 2023

Statewide Transition Plan

January 16th, 2023

Adoption Date of HCS Rules and Status of Statewide Transition Plan (STP): 

gave HHSC preliminary approval of its STP on 12/21/2022.  The STP will be posted for public comment this Friday (Jan. 20th, 2023).

It is unclear when the HCS rules will be adopted.

See graph of draft rules below (pages 12-17 for HCS).  Includes CLASS, TxHML, MDCP, and DMDB programs as well.

Appendix A: Home and Community-Based Services (HCBS) Settings Statewide Transition Plan

January 15th, 2023

TMHP Recoupment Letters

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.

Read the full alert.

Help With The New Residential Agreements

Have You Signed Up For CIMS (Critical Incident Management System)Yet? 

January 12th, 2022

From our good friends at the Texas Chapter of AAIDD, some important info about the Texas 88th Legislative Session

See actual TAAIDD link  

Employment Assistance & Supported Employment Training Options From HHSC

January 12th, 2022

August 1st, 2021

June 28th, 2021

There are two Home and Community-based Services and Texas Home Living trainings in this series:

• HCS and TxHmL Employment Assistance Training
• HCS and TxHmL Supported Employment Training

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.

• HCS and TxHmL Employment Assistance Quiz
• HCS and TxHmL Supported Employment 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.

• Direct Service Workers Training
• Direct Service Workers Quiz

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.

https://aspr.hhs.gov/legal/PHE/Pages/covid19-11Jan23.aspx

January 11th, 2023

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

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

January 10th, 2023

Below are just some of the trainings offered by HHSC on their “Trainings Initiative” page. Some live and some via webinar.

For more information, please go to: https://www.hhs.texas.gov/providers/provider-training/training-initiatives

SSI/SSDI Benefits Overview

The SSI/SSDI Benefits Overview web-based training provides a basic foundation for understanding Supplemental Security Income and Supplemental Security Disability Insurance and provides contact information for people who can help you further understand these programs. The training has a corresponding quiz.

• SSI/SSDI Benefits Overview Training
• SSI/SSDI Benefits Overview Quiz

Employment First

The Employment First web-based training covers Texas’ new Employment First policy. The training has a corresponding quiz.

• Employment First Training
• Employment First Quiz

Visit the HHS Employment First website.

HCS and TxHmL

There are two Home and Community-based Services and Texas Home Living trainings in this series:

• HCS and TxHmL Employment Assistance Training
• HCS and TxHmL Supported Employment Training

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.

• HCS and TxHmL Employment Assistance Quiz
• HCS and TxHmL Supported Employment Quiz

Direct Service Workers

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.

• Direct Service Workers Training
• Direct Service Workers Quiz

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!”

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.

January 2nd, 2023

Effective January 2023, the open enrollment application process to get a provisional contract to provide Home and Community-based Services (HCS) and Texas Home Living (TxHmL) services will change.

1. You must be enrolled as a Texas Medicaid provider through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment System (PEMS) before applying.

2. To apply, you must complete the Provider Applicant Training (PAT). The PAT is now available on the HHS Learning 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.

PAT FAQ’s.  Please read before taking the PAT! 

You must pass this test by 85% and if you fail the 1st x will have to wait 6 months to retake it!

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.

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.

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. 

Read more……

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 Hurricane Evacuation Transport to General Population Shelters during the COVID-19 Pandemic

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

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

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.

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.

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,