Twogether Updates

HCS Provider Applicant- Provider Applicant Training (PAT) and Test Information Update

HCS Provider Applicant- Provider Applicant Training (PAT) and Test

Okay, for those of you who are going through the HCS or TxHmL provider applicant process and had your application approved, a lot of people are contacting me inquiring about when the orientation (PAT) and testing are going to happen as some of you have been waiting a very long time.

Just FYI- I am unclear about testing. It may be online now, but I have also heard it may not be and it is still on hold due to COVID-19.

What I do know is that the orientation or what is now called the Provider Applicant Training, has been available online since at least April or May of this year, through the HHSC e-learning portal.

If you received your application approval letter with a link to the online portal PAT training when they just started and you have completed your Provider Applicant Training (PAT) and printed the certificates, and still have not received an invitation to take the test yet, please go back and login to the e-learning orientation in the portal. If you log in and it no longer says 100% complete, and now says something like 80% complete, you will need to go back into the complete it.

They apparently have added some new steps at the end of the Provider Applicant Training (PAT), that was not there when you completed your initial orientation and printed your certificates. There is an evaluation for step 3 and I believe there is a step 4. I think step 4 is some kind of attestation that you are the individual that will be taking the HCS or TxHmL applicant test. In other words the Program Manager.

I am unclear as to why there was no notification of the changes in the e-learning process and that you would have to go back and complete that before HHSC can approve you at 100%, but that could be why you have not heard back about testing for quite some time.

In addition, there are 2 persons listed as test approvers for the portal, I believe in just the past few days, according to some of you who have done the online orientation process.  My guess is this probably means that HHSC is very close to getting back to Provider Applicant Testing, but that it will be online. I am hopeful that many of you out there can finally take your test and get your certification to become a provider.  I know some applicants have been in limbo for quite some time.  Last information we received indicated the test will be online and will be offered sometime between Dec. 2020 and Jan. 2021.  The PAT applicant will have to schedule a time to go to a testing “site” and to take the test online with a “proctor” in the room to monitor the test being taken “online”.

Remember to get prepared and please study. You may have been waiting a long time to test, but I know that applicants sometimes don’t study as much as they need to, to take the test.  If you have come this far, you do not want to fail the test and have to start all over again!  Please contact us if you need help in preparing for the test.  We do provide services such as study prep sessions, practice tests, etc..

Letter From Twogether Consulting To Providers-Update

November 23rd, 2020

Hello Friends,

Please check out our “Updates” page.  It has been reformatted so you are able to navigate from one “post” to the other. If you want to read more on each section, just click on “read more”.  We have also updated the “Off-site Services” page so that you can pay for hours of off-site consultation right on the same page.  Remember there is a discount for blocks of time larger than 3 hours, purchased on the site.  This discount is only available online on this “Off-site Services” page. Twogether Consulting also has also added our “Store” page on the dropdown menu under “Services”.  In addition to the off-site hourly packages in the “Store”, we will be adding some additional services in the near future for a flat rate, for purchase on this page..

Currently, all our services are technically “off-site”, due to COVID-19, but these consultation package prices on the “Off-Site Services” page are only for just that, consultation by phone, email, video chat, or text. They do not include our rates for developing policies and procedures, LON increase request packets, or any other services we provide.

Twogether Consulting is continuing to work to ensure minimal disruptions to our business while putting the safety and well-being of our providers, their individuals in the program, and our contractors as our highest priority. Please see below for specific information:

  • In-person group trainings/conferencesSuspended until at least January 31st, 2021 at this time.  Most of these classes have already been moved to online webinars or training.  We also have pre-recorded sessions of some of these trainings as well.
  • Online training (Webinars): Proceeding as planned.  We will be posting upcoming webinars to the website regularly on the homepage: www.twogetherconsulting.com 
    • Webinar Registration:  Click on calendars on our website at www.twogetherconsulting.com or https://events.time.ly/anatx6f
    • Recordings of Free Webinar Series:  https://www.gotostage.com/channel/3b0bd3b1a47c4e80be974f4bcfa54d7b
    • “Updates Page”  https://twogetherconsulting.com/updates/
    • We will continue to provide 1 on 1 webinar training and any general trainings done for a specific facility/ provider for Care Coordination, Nursing Services, Direct Support Staff, etc.…
    • We have pre-recorded sessions with handouts for those of you who can’t attend live sessions or can’t wait for a live session. They range from $25-$150 per session.  These range from 1 hr- 3.5 hrs per session.
    • “Pop-Up Webinars”:  We will occasionally send out invitations to some webinars to those of you who are already clients of Twogether Consulting or who are on our mailing listThese won’t be posted for the general public.  These will be fairly short notice and based on topics that we receive a large number of requests to provide.  They will also be limited registration.  (15-30 persons max).
    • Direct Support Staff Training Webinars:  We continue to offer DIT’s (Directive Inservice Trainings) for ICF as well as General Direct Support Training for HCS/TxHmL/ICF providers.  Here are just some of our training webinars currently available live and/or via pre-recorded sessions:  Abuse/Neglect/Exploitation, Direct Support Documentation (Service Delivery Logs/Residential Notes, Incident Reports, Behavioral Support Documentation and Data Collection, and Training Data Collection),  Elements of the Behavior Support Plan & The Importance of Your Documentation, Expectations From the Nurse of The DSP (Includes discussion of Medical Documentation as well-MARS, Medication Errors, Treatment Sheets, Significant Observations),  When and What to Report To The Nurse, SAM’s Training (Self-Administration of Medications Training To Staff-General Routes, Tasks, documenting), Preparing For Survey in the Group Home/Surveyor Expectations in the Group Home, Host Home/Companion Care Service Provider Responsibilities, What The Nurse Expects from the HH/CC Provider and/or CRA, and many other training webinars.
  • Consultant Support: Twogether Consultants continue to be available to assist with your HCS/TxHmL and ICF needs as usual.  We will provide anything you request of us, that we can off-site.
    • Off-site Consultation:
    •  You may purchase a block of time for as-needed consultation:  We charge $75/hr and we can offer blocks of time for more than 3 hrs at a slight discount if you pay online at: https://twogetherconsulting.com/services/off-site-services/
    • if there is an extensive project (anything over 6 hrs, we will discuss flat rate options or daily rates.)
    • We continue to provide as-needed off-site consultation including, but not limited to: Development or assistance with policy and procedure, Monthly/Quarterly QA via Taskmaster Pro, Therap, or any other cloud-based services, Survey and Audit Prep, and you are welcome to contact us if you need us to QA or review documents through our secure cloud storage system. We also provide off-site nursing consultation and mentoring for HCS/TxHmL and ICF programs,
    • And much more!
  • On-site Consultation:  This service is temporarily suspended at this time, due to the recent Guidelines from HHSC for HCS/TxHmL providers as of 3/17/20 by HHSC.  See link below:
  • https://apps.hhs.texas.gov/providers/communications/2020/letters/PL2020-12.pdf
  • We are not considered “essential visitors” at this time, according to HHSC.
  • Concerning our ICF providers, we will follow the same guidelines ICF has provided at this time.
  • Remember for ICF we can still provide Directive Inservice Trainings (DIT) if necessary, but we prefer to provide these off-site via webinar, and most Regional Surveyors will accept a DIT via webinar, especially in these times. So please let us know. If this must be done in person, it must be for 8 or less attendees at a time. All attendees must be screened for possible Covid-19 symptoms.
  • Payments:  We prefer payment via our PayPal Invoices, with Credit Card/Debit/ or PayPal.  You are also welcome to pay via e-check, or request to pay by Venmo.  You may also use our online link below to pay:  https://twogetherconsulting.com/payments/
    • If you must pay by check, please let us know prior to mailing the check.  Thank you.  Send all checks to:

Twogether Consulting  P.O. Box 90426 Austin, Tx 78709.

Any updates to our COVID-19 response will be posted at:  https://twogetherconsulting.com/updates/

Note: We will continue to send out the newsletter 2 x per month.  If you want to me on the mailing list, please contact us at:  info@twogetherconsulting.com

You may contact us by phone with any questions at:  512-294-8032.  You may email me directly at:  javasbja@aol.com or javasbja@gmail.com

Thank you and be well,

Julie Andrews Blacklock/Owner & IDD Waiver Consultant

 

HCS Certification Principals Training Webinars & Recordings

November 12 Recording of Certification Principles:

Staff Member and Service Provider Requirements Webinar for HCS and TxHmL Providers Available

A recording of the November 12, 2020, Certification Principles: Staff Member and Service Provider Requirements webinar for HCS and TxHmL providers is available for those unable to attend.

View the webinar recording here.


November 19 Recording of Certification Principles:

Restraints and Prohibitions Webinar for HCS and TxHmL Providers Available

A recording of the November 19, 2020, Certification Principles: Restraints and Prohibitions webinar for HCS and TxHmL providers is available for those unable to attend.

View the webinar recording here.

BinaxNOW COVID-19 Test Training Link

November 22nd, 2020

Navica and BinaxNow Covid Ag CardUpdated Training Link Available for the BinaxNOW COVID-19 Test

A BinaxNOW COVID-19 Ag Card training video that provides detailed step-by-step guide to the test process is on the Abbott website. The training video is for people without medical training, who will conduct COVID-19 testing using the BinaxNOW Ag card. As part of the request for free BinaxNOW test kits, providers will confirm that staff performing the COVID-19 tests have completed the BinaxNOW COVID-19 Ag Card training.

The BinaxNOW COVID-19 Ag Card (PDF) is a rapid point-of-care antigen test which detects the presence of antigens in persons infected with the virus that causes COVID-19. This test is approved for use under an Emergency Use Authorization by the Food and Drug Administration.

View the free online training here


HHSC Publishes Revised Attestation for Free Testing Kits

HHSC has published a revised attestation form for free BinaxNOW point-of-care antigen COVID-19 test kits for NF, ALF, ICF, HCS and HCSSA providers. The form was revised to correct the BinaxNOW training link required for staff who do not have medical training and will be administering the COVID-19 tests using the BinaxNOW Ag card.

Flu Vaccine Guidance During COVID-19

HHSC Publishes Flu Vaccine Guidance During COVID-19 (PL 20-50)

HHSC publishes Provider Letter 20-50 Influenza Vaccine Guidance During COVID-19. The letter provides a brief overview of the Adult Influenza Vaccine Initiative and guidance on the administration of the influenza vaccine to residents and staff with and without COVID-19.

The letter also informs facilities when an individual should receive the influenza vaccine, even if the facility is not the vaccine administrator.

Don’t Forget Annual Vendor Submission Due (Nov.1st-Jan31st) HCS/TxHmL!

HCS and TxHmL Annual Vendor Submission Timeframe
NEW LOGO - SMALLER
Blue Gradient

HCS and TxHmL Annual Vendor Submission Timeframe

The timeframe to submit for annual vendor approval is Nov.1, 2020 through Jan. 31, 2021. Required documentation for annual vendor requests are in the HCS and TxHmL Billing Guidelines, Section 6160(b)(2), Approval of Annual Vendor. Email packet submissions to Billing and Payment with the subject line: Annual Vendor Approval. Submissions sent to any other email addresses may not be received.

If you are unable to meet the deadline to submit, please request an extension by emailing Kaliope Schmidt, the Billing and Payment manager. Email Billing and Payment or call at 512-438-5359 with your questions.

Free Webinar Series

Our free webinar session recordings previously recorded are currently posted on our “Gotostage” page.

 We are pleased to announce our first guest presenters for  January 2021!

Free Webinars!!

 


Guest presenters:

Brittany Brown/Insurance Broker

Date:January 12th, 2021

TimeNoon-1pm (Central Time)

Cost:  Free!!!

Where:  Webinar

To register for the session:

Please register for Free Webinar: Presented By AssuredPartners (Texas) Group Health Insurance “Employee Advocacy & Long-Term Strategic Planning For on Jan 12, 2021 12:00 PM CST at:

https://attendee.gotowebinar.com/register/8401752488419813645

After registering, you will receive a confirmation email containing information about joining the webinar.

Brought to you by GoToWebinar®
Webinars Made Easy®

 

Brittany and her team help to provide assistance for finding group health insurance benefits for companies with 40+ employees.  They provide a 2-year blueprint on approaching health benefits strategically.  You can receive one of these “blueprints” for free, even if you are not signed up with them yet.  Please contact Brittany for more information if you would like to have a custom “blueprint” completed for your facility/company. They are the 12th largest agency with offices all over.  Brittany is located in the Houston area but can work with you wherever your facility or company is located.  If your company insurance for your employees is not adequately covering costs or is now too much for your employees to afford, then they can help you to find what will work for you and your company. They have locations in the Dallas and Houston areas as well as other cities in Texas.

For more information contact Brittany Brown at:  Brittany.brown@assuredpartners.com 

You may also go to their website at: https://www.assuredpartners.com/Houston 

Previous Free Webinars in Oct. and Nov. 2020- Liks to Recorded Sessions Available Below !

 

Guest presenters:  Erin Langlais & Mitchell Deter

From:  ADP Payroll & HR Services

“As more people continue to return to the workplace, ADP is excited to share tools that are designed to help them, and their people transition back safer, easier, and more effectively. ADP’s free webinar will provide guidance on how to return to the workplace safely and compliantly, and cover topics like the Payroll Tax Deferral Memorandum, and how to accurately classify 1099 vs. W-2 employees.”

Date: Tuesday October 27th, 2020 (Session ended)

Time:  Noon-1pm (Central Time)

Cost:  Free!!!

Watch recorded webinar session at the link below:

https://1drv.ms/v/s!AsXbls7Zifn4nW5JmM1v4LJYt5kW

Topic:  “ReturnTo Work” COVID-19 Concerns & Provider Resources

(Including Information on Property Tax Deferral Memorandum!!)

“As more people continue to return to the workplace, ADP is excited to share tools that are designed to help them, and their people transition back safer, easier, and more effectively. ADP’s free webinar will provide guidance on how to return to the workplace safely and compliantly, and cover topics like the Payroll Tax Deferral Memorandum, and how to accurately classify 1099 vs. W-2 employees.”


HRS Inc

Guest presenter:

Hillary Gaytan  (Business Development Representative)

From:  HRS

Date: Wednesday -October  28th, 2020  Session Ended

Time:  Noon-1pm (Central time)

Cost:  Free!!!

Where:  See recorded link below:

https://attendee.gotowebinar.com/recording/3788852608729403404

Here is a link to a short, introductory video about the HRST: https://hrstonline.com/video/index.php?id=410335893

Topic:  Health Risk Screening Tool

HRST  (Health Risk Screening Tool) is an assessment tool that can identify & detect health risks in vulnerable populations. This tool and other services offered by HRS are based on person-centered practices. Here is a little more information about HRS from their website. The Health Risk Screening Tool (HRST) identifies and tracks health risks in vulnerable populations, making it possible to design a plan tailored to meet the unique health and safety needs of each individual in the least restrictive setting. The instrument can objectively justify resources allocated both financially and in service intensity. Used by Case Managers, supervisors, and direct support professionals. HRS also helps the provider to comply with CMS Rules and assist with Person-Centered planning and continuity of care.  It is field-tested, reliable, and user-friendly

“Health Risk Screening, Inc.’s roots began in 1992. Along with training courses, webinars, and materials, HRS is the sole developer, producer, and distributor of the web-based Health Risk Screening Tool (HRST). The HRST is the most widely used and validated health risk screening instrument for people with intellectual and developmental disabilities.

HRS was established on the principles of person-centered practices. Our founder, Karen Green McGowan was a pioneer in the early formative days of the person-centered movement..  Our focus is on developing tools and training for the person-centered support of vulnerable populations. Through the education of government agencies and service providers, we have helped improve people’s lives. Along with training courses, webinars and materials, HRS is the sole developer and distributor of the web-based Health Risk Screening Tool (HRST). The HRST is the most widely used and validated health risk screening instrument for people with disabilities.”

For more information, please contact  Hillary Gaytan at:  Phone: 727.754.9539  Emailhilary@hrstonline.com
You can also go to their website:  www.hrstonline.com 

Check out this great page they have devoted to COVID-19 Resourceshttps://hrstonline.com/covid-19-resources/

 


HRS Inc

Guest presenter:

Patrick Lane  (PCT Mentor & Trainer)

From:  HRS

Date: Thursday -November 12th, 2020  (Session ended)

Time:  11am-12pm (Central Time)

Cost:  Free!!!

Where:  See recorded link below:

https://attendee.gotowebinar.com/recording/1049673375643527182

Topic:  Person-Centered Services 

Patrick will be talking about some of the Person-Centered Services offered at HRS including software that helps the provider develop Person-Centered Descriptions. These can be used as a resource for making annual plans Person-Centered by using these same person-centered skills practiced in PCT sessions. 

“Person-Centered Planning Training is designed to help you approach support from a more holistic angle, with person-centered practices that respect the autonomy of those with intellectual and developmental disabilities while providing them with the highest possible level of care.”

Improve The Quality of Life

  • Balancing personal choice with personal responsibility by establishing and maintaining things that are important to the person with things that are important for the person
  • Being integrated in one’s community so that the person is known and respected for her or his contributions.
  • Being respectfully communicated with as a person, using language consistent with being a typical adult as opposed to using clinical or system language
  • Receiving support that is consistent so that new staff and others know and respect the person’s values and choices, as well as how others can help the person.
  • Being matches with staff, housemates, or others that the person making life more enjoyable.
You can contact Patrick at: patrick@hrstonline.com     For more info about HRS PCT services, please see the following link: https://hrstonline.com/person-centered-services/

 


 

Guest presenter:

Steve Cardie

From:     Abundant Health

Date: Tuesday -November 17th, 2020  (Session ended)

Time:  Noon-12:45 pm (Central Time)

Cost:  Free!!!

Where:  See link to the recorded session below:

https://attendee.gotowebinar.com/recording/5931551182568587528

Topic:  Cellular Blood Pressure Monitoring System   (Free To Medicare Patients!)  

Abundant Health is the distributor of a remote blood pressure monitoring system for Medicare patients that is the best on the market. It is the only FDA approved cellular blood pressure monitor. It makes it easy to report regular blood pressure monitoring to your physician with little to no effort and proving complete HIPPA compliance.  The system is much like your standard wrist BPM cuff, but it has a SIM card in it that reports all data instantly to your physician and can supply records that can be printed out by the client or facility for the individual’s records.  This would be a great system as well for individuals living in their own family home or in a host home setting that may want to be as independent as possible or may cut down on needing as much staff assistance and/or supervision.  Abundant Health works with providers, clinics, hospitals, and physicians across the country.   Here is a quote from one of them:

“Our new Cellular Blood Pressure Monitor System connects automatically to cell towers and transmits your patient’s information directly to your practice. This device makes it simple for seniors who tend to be more technology challenged to utilize Medicare’s RPM program without the difficulty of connecting to cell phones or the internet. No passwords, no Bluetooth, no internet connections required.

The rapid advance of medical device design plus an enormous upgrade in telecommunications makes Remote Patient Monitoring (RPM) suddenly possible for virtually everyone. Anywhere.  In November 2018 CMS officially approved three new billing codes for Remote Patient Monitoring (RPM).  The telehealth industry experts agree that this is the biggest financial incentive to date in the history of digital medicine.”

Register for the webinar at    https://attendee.gotowebinar.com/register/3642654945259750160

You can contact Ayshe at:

 


Guest presenters:

Brittany Brown/Insurance Broker

Date: January 12th, 2021

TimeNoon-1pm (Central Time)

Cost:  Free!!!

Where:  Webinar

Brittany and her team help to provide assistance for finding group health insurance benefits for companies with 40+ employees.  They provide a 2-year blueprint on approaching health benefits strategically.  You can receive one of these “blueprints” for free, even if you are not signed up with them yet.  Please contact Brittany for more information if you would like to have a custom “blueprint” completed for your facility/company. They are the 12th largest agency with offices all over.  Brittany is located in the Houston area but can work with you wherever your facility or company is located.  If your company insurance for your employees is not adequately covering costs or is now too much for your employees to afford, then they can help you to find what will work for you and your company. They have locations in the Dallas and Houston areas as well as other cities in Texas.

For more information contact Brittany Brown at:  Brittany.brown@assuredpartners.com 

You may also go to their website at: https://www.assuredpartners.com/Houston 

 

 

ICF/IID Updates

HHSC Publishes Revised Reporting Guidance for Long-Term Care Providers

(PL 20-37)

HHSC has published a revised version of Provider Letter 20-37, Reporting Guidance for Long-Term Care Providers (PDF). The revision includes information for ALF and ICF providers offering point-of-care testing for COVID-19 and clarifies reporting requirements for NF providers.


November 22nd, 2020

November 30 ICF Provider COVID-19 Webinar with HHSC LTC Regulation

LTCR and DSHS provide the latest information on the COVID-19 pandemic and take live questions from participants in this ICF provider webinar. Provider attendance is critical to staying current with COVID-19 requirements and guidance.

ICF/IID providers are strongly encouraged to attend this and all biweekly COVID-19 webinars with HHSC Long-term Care Regulation and the Department of State Health Services.

Those using Internet Explorer may have difficulties registering for the webinar. Please try another browser such as Google Chrome or Microsoft Edge.

ICF Provider Webinar

November 30, 2020

11 a.m. – 12:30 p.m.

Register for the COVID-19 webinar.


Recording of November 16 ICF COVID-19 Q&A Provider Webinar Available

A recording of the November 16, 2020 ICF/IID COVID-19 Q&A with HHSC LTC Regulation and DSHS is available for those who could not attend.

View the COVID-19 Q&A recording.

View the COVID-19 Q&A (PDF).


10/16/20

Important Information!

LTCR FORM 2195: Expansion of Reopening Visitation Status Attestation and Letter PL 20-43 (for ICF Only)

Note: to receive an approved general visitation designation, a small ICF/IID that cannot provide separate areas, units, wings, halls, or buildings for individuals who are COVID-19 positive, COVID-19 negative or unknown COVID-19 status, based on the status of the entire facility, must:

  • have no facility-acquired COVID-19 cases in individuals for at least 14 consecutive days; and
  • have no COVID-19 cases in staff.

An ICF/IID must provide instructional signage throughout the facility and proper visitor education regarding

  • signs and symptoms of COVID-19;
  • infection control precautions; and
  • other applicable facility practices (e.g., the use of facemasks or other appropriate PPE, specified entries and exits, routes to designated visitation areas, and hand hygiene).

An ICF/IID that does not meet the criteria for a visitation designation must permit closed window visits and end-of-life visits for individuals regardless of their COVID-19 status, as well as essential caregiver visits for individuals with COVID-19 negative or unknown COVID-19 status.

Such an ICF/IID must also develop and implement a plan to meet the visitation criteria and submit the plan to the regional director in the Long-term Care Regulation (LTCR) region where the ICF/IID is located within five days of submitting the new 2195 Expansion of Reopening Visitation Status Attestation Form,

or

within five days of receiving notification from HHSC that the ICF/IID was not approved for general visitation designation. 


LTCR Form 2195

Each ICF/IID must submit LTCR Form 2195 to the Regional Director in the LTCR region where the facility is located and must provide information about whether the ICF/IID meets or does not meet the criteria for expanded general visitation.

Each ICF/IID must submit a completed form 2195 to the Regional Director no later than October 31, 2020.

An ICF/IID that does not meet the visitation designation criteria must attest that it:

  • is permitting closed window visits, end of life visits, and essential caregiver visits;
  • will develop and implement a plan to meet the visitation designation criteria as defined in 26 TAC §551.47; and
  • has included the plan with the form or will submit the plan within five business days of submitting the form.

To seek a designation for general visitation, an ICF/IID must complete LTCR Form 2195, Expansion of Reopening Visitation Status Attestation, to notify LTCR that the ICF/IID seeks a designation as a visitation facility.

The form must be emailed to the LTCR regional director in the LTCR region where the facility is located. Any applicable pictures and facility maps must also be included with LTCR Form 2195.

The LTCR regional director or designee will review the form within three working days of submission and notify the ICF/IID whether it has received been approved for a visitation designation.

An ICF/IID with previous approval for visitation does not have to submit LTCR Form 2195 or other documentation unless the previous visitation approval has been withdrawn, rescinded, or canceled, or was for only indoor or outdoor visitation instead of both indoor and outdoor visitation.

If approved, the ICF/IID must allow outdoor visits, indoor plexiglass visits, open window visits, and vehicle parades in accordance with the applicable emergency rule. HHSC LTCR can conduct an on-site visit to confirm an ICF/IID’s compliance with the requirements. If HHSC determines that the ICF/IID does not meet the requirements for the designation as a visitation facility, the ICF/IID must immediately stop all visitation except a closed window visit, end-of-life visit, and visits by persons providing critical assistance, including designated essential caregivers.

If, at any time after a visitation designation is approved by HHSC, the ICF/IID experiences an outbreak of COVID-19, the ICF/IID must notify the Regional Director in the LTCR Region where it is located that the ICF/IID no longer meets visitation criteria, and the ICF/IID must immediately stop all visitation, except a closed window visit, end-of-life visit, or visits by persons providing critical assistance, including essential caregivers.

The ICF/IID can submit a new request for designation when it meets all visitation criteria.

Under Section 37.10 of the Texas Penal Code, a person commits a criminal offense if he or she makes a false entry in a governmental record; makes, presents, or uses any record or document with knowledge of its falsity and intent that it be taken as a genuine governmental record; or makes, presents, or uses a governmental record with knowledge of its falsity. In addition, making a false statement on the attestation form can result in the imposition of an administrative penalty as described in Texas Health and Safety Code, Chapter 252, section 252.065(a)

Contact Information for Submitting LTCR Form 2195 to the LTCR Regional Director: https://hhs.texas.gov/about-hhs/find-us/long-term-care-regulatory-regional-contact-numbers

If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at PolicyRulesTraining@hhsc.state.tx.us or call (512) 438-3161.


10/05/20

Deadline for Decision To Return to Facility/Payment to Hold Bed/Discharge Option  

HHSC Email  Update
“These information letters listed below, provide confirmation of the agency’s intent to seek CMS approval for a retainer or bed hold payment, discusses the emergency rule, and directs providers to share prepared information with clients who are affected by these changes. We understand that the turnaround time to inform clients and their families is minimal; however, we wanted to give families time to decide next steps and providers time to adjust to the families’ decision.”  (November  1st, 2020 is the deadline).  Basically if the individual has been away from the facility during COVID-19, they will need to make a decision of whether they are coming back to occupy a “bed”, pay themselves to keep the “bed” or if they will discontinue services (discharge) without receiving any ICF services at this time.  There is a sample letter to send to the individual and their families to get them ready to make this decision.

Information Letter No. 20-43 ICF/IID Services During COVID-19


10/03/20

Quick TIPS on New Changes for Expansion of Facility Visitation Rules & Other Policies Concerning COVID-19

Essential Caregiver Visits and Salon Services Visitor   (Visitor types above and beyond normal designated visiting facility type)

Essential Caregivers are allowed even if the facility does not have designated visitation.  They must be at least 18 years of age.  Can be family, friend, guardian.

  • 1.They must wear a facemask. 2. They must have evidence of negative COVID-19 test in the past 14 days and must be screened by facility staff prior to the visit.  (Pay attention to the new additional symptoms and discontinuation of asking about international travel). 3. There is a 2- hr limit unless the facility allows a longer period of time. 4.They can have physical contact with their individual (and only their individual)  5.They must be limited to access to their person.  6.An assigned person must escort them to and from the location they are going to meet with the individual- room, outside…  7. The facility must approve the face mask they are going to wear or provide an appropriate mask.  8.If they do not have an appropriate face mask or the facility can’t provide one, they will need to reschedule the visit. 9. The facility must create an identifying badge for the essential caregiver or any salon service visitors. 10. The facility must have attestation stating the essential caregiver has visited and when they left (include time arrived, when they left, who they visited).  11. Essential caregivers must be trained on PPE and how to wear PPE, handwashing, and other infection control practices and there must be proof of this training that the facility maintains.   12..The individual must be COVID-19 negative to have an Essential caregiver visit or Salon Service Visitor.
  • ***(If client status is unknown, the essential visitor would have to wear a face mask (not N-95, save that for your staff who need to work with COVID-19 + individuals), gown, gloves, goggles or face shield, so the facility might need to provide these other items)

Phase I Visitation Rules, no longer in effect!

Expanded Visitation Rules now in effect:  The facility must apply with form 2194  for the Designated Visitation Facility, do not require all these same requirements an essential visitor (or Salon Service Visitors)- Designated visits include: open window visits, closed window visits, parade visits (open window or closed) outside visits, (and in plexiglass separate areas).   Must use physical distance, visitor screening, individual will wear face mask or face covering if tolerated and the same for the visitor -they must wear a face mask or face covering.  Provider Letter 20-38 has the link with form 2194 at the end of it.  We encourage you to email the form.  Most staff at HHSC are not in the office  Visitation Designation department has 3 days to approve or deny the 2194 form request.  Only the administrator or director can fill out form 2194!!

Previous Level 1 Attestation Approval: If you previously submitted the 2192 and received approval, you do not need to request a new one with form 2194, if your status is the same.  If you want to change the visitation type, then you will need a new form. ( i.e. you did not want plexiglass partition previously and now you do.)

Small facilities must request visitation designation for the whole facility (unless you have a way to separate all cohort areas completely.) Do not fill out section #3.  That is only for NF’s. 

The provider must develop and must enforce policies and procedures including testing strategies for Essential Visitors, in addition to the testing that must occur at least 14 days prior to 1st visit and all other polices related, such as essential visitor requirements discussed above.  Remember your testing strategies  are required  to provide expectations for the essential visitor for how often they will be required to test and when, for any visits they are making, after the initial “essential caregiver visit”.

For vehicle parades, the individual needs to remain 10 ft or more from the vehicle for safety.

Plexiglass booths on the inside must be approved by a life safety person for your region Send in pictures.  Does have to be a plexiglass barrier, does not have to be 2 and 3 sided.

**Closed window and End of Life visits are the only visits an individual may have if they are COVID-19 + (positive)

Remember staff should be assigned to an appropriate cohort (COVID-19 +, COVID-19 Negative or Unknown) then they should stay with that Cohort.  In addition, there should be a policy at the facility for limiting the sharing of staff.  If you need help with your policy concerning “COHORTS” and ” Mitigation of COVID-19 by Limiting Sharing of Staff”, please contact us.  I do have some policies you can purchase if needed.  Please contact me at:  info@twogetherconsulting.com


 

FAQ’s (June 2020)

(Section) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)
31.Question:
How should an ICF handle the discharge summary when a client is admitted on a temporary emergency basis from the community or another ICF?

Answer: Regulations regarding ICF/IID discharge have not been waived. A discharge, even on a temporary emergency basis, requires that key developmental, behavioral, social, health and nutritional information be shared with the accepting facility in the community or non-facility provider. CMS is aware that staffing shortages and/or client surges due to the PHE create a high demand on available staff time that makes it difficult to complete a full discharge summary for each client. Each ICF will need to evaluate what amount and detail of documentation is necessary to ensure that critical health information is shared with the accepting facility or other provider. When available and if appropriate, the Interdisciplinary Team (IDT) should maximize the use of telehealth for the completion of a client’s discharge plan during the PHE.

32.Question:
How should an ICF handle the development of a Comprehensive Functional Assessment (CFA) and an Individual Program Plan (IPP) when a client is admitted on a temporary emergency basis from the community or another ICF?
Answer: Clients who are admitted on a temporary emergency basis to an ICF during the PHE will nonetheless continue to need to have a Comprehensive Functional Assessment (CFA) and an Individual Program Plan (IPP) in accordance with 42 CFR 483.440(c). Completion of these documents will provide an opportunity for the IDT and staff to meet the basic and critical care needs of the client. CMS is aware that staffing shortages and/or client surges due to the PHEmay create a high demand on available staff time that makes it difficult to complete a full CFA and IPP. Each ICF will need to evaluate what amount and detail of documentation is necessary to ensure that critical health and treatment information is identified to allow active treatment during the PHE. This health and treatment information will support successful adjustment for the client to the new temporary living environment. When available and if appropriate, the IDT should maximize the use of telehealth for the development of a client’s IPP for temporary emergency admissions during the PHE.
33.Question:
During the PHE are ICFs still required to have and use a specially constituted committee or committees?
Answer: Yes. CMS believes that the use of this committee may be of value during the time of the COVID-19 PHE. The committee can provide an opportunity to support and make suggestions to facilities as they may need to adapt policies and procedures as well as why and how services are being provided to clients, which clients may find difficult to understand and potentially lead to inappropriate adaptive behavior. When available and if appropriate, the specially constituted committee should maximize the use of telecommunications to convene this committee as a resource to support the challenges faced by staff and clients during the PHE.
34.Question:
When a client has tested positive for COVID-19 and the ICF/IID implements quarantine procedures, client rights are immediately abridged and severe behaviors are likely to occur. What is the guidance from CMS on balancing the CDC expectations with the rights of the individual?
Answer: The health and safety of the clients, visitors, and staff at an ICF/IID are of the utmost importance for CMS. Based on the ICF Emergency Preparedness plan, and in accordance with the requirement at 42 CFR 483.440(c)(3)(v) that the IPP assess the client’s health status in the context of a COVID-19 diagnosis, the ICF/IID must revise the client’s IPP to reflect specific procedures and steps that will be taken to quarantine the client while also taking every step reasonable to protect the rights, safety, and health of the infected client, as well as those of the staff and other clients. ICF/IIDs are encouraged to use telehealth and assistive technology to minimize social isolation to the extent possible.
35.Question:
Are intermediate Care Facilities required to participate in the COVID-19 CDC National Healthcare Safety Network (NHSN) reporting requirements?
Answer: ICF/IIDs do not have a regulatory requirement for the reporting of communicable diseases, healthcare-associated infections, and potential outbreaks to Federal (such as the CDC), State and/or local health departments. ICF/IIDs do have a requirement under 42 CFR 483.420(c)(6), which addresses communication to family and/or guardian when a client’s condition changes, including the onset of serious illness (such as COVID-19). Although reporting to CDC is not required, ICF/IIDs may voluntarily report COVID-19 cases to the CDC, and CMS encourages them to do so to facilitate public health tracking of the pandemic. You may find the following CDC resource links helpful:
Rural Health Clinics (RHC)/Federally Qualified Health Centers (FQHCs)
36.Question:
Has CMS implemented any flexibilities to help RHCs and FQHCs respond to the PHE posed by COVID-19?

Answer: Yes. CMS has temporarily waived certain regulatory requirements providing flexibilities to assist RHCs and FQHCs in furnishing services during the COVID-19 PHE. This includes temporarily modifying the following:(a)50% mid-level staffing requirement for RHCs;(b)Physician supervision requirement for nurse practitioners (NPs), to the extent permitted by State law; and(c)Location requirements for existing RHCs and FQHC to allow additions of temporary service locations.Please see https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf for additional waiver information. Additional flexibilities, including guidance for RHCs and FQHCs furnishing telehealth services during the PHE, are also described in this CMS MLN Article: https://www.cms.gov/files/document/se20016.pdf

37.Question:
When do these flexibilities go into effect?
Answer: The flexibilities for staffing requirements, physician supervision of nurse practitioners, and temporary expansion sites are retroactively effective beginning March 1, 2020, through the end of the emergency declaration and CMS issues an end of outbreak notification.
38.Question:
Do these flexibilities apply to all RHCs and FQHCs?
Answer: The flexibilities for physician supervision of NPs apply to all RHCs and FQHCs, to the extent permitted by state law. Flexibilities to the 50% mid-level staffing requirement apply to RHCs only as the mid-level requirement is RHC specific. Lastly, flexibilities to the location requirement apply to existing RHCs and FQHCs.
39.Question:
How does the mid-level practitioner 50% flexibility benefit an RHC? Are RHCs required to submit any documentation to CMS for this waiver?
Answer: This waiver provides RHCs with flexibilities with regards to the percentage of operating hours the facility has a mid-level practitioner available to furnish patient care services. While the waiver offers flexibilities with staffing mixes, a physician, NP, physician assistant, certified nurse midwife, clinical social worker, or clinical psychologist must be available on site to furnish patient care services whenever the RHC is open and operating. CMS does not require any submission of documentation for this waiver.
40.Question:
How does the waiver affect the physician supervision of NPs?
Answer: During the PHE, NPs may function to the fullest extent possible without physician supervision, and to the extent of applicable state law. However, the physician continues to be responsible for providing the overall medical direction for the RHC/FQHC’s health care activities, consultation for, and medical supervision of all other health care staff, either in person or through telehealth and other remote communications.
41.Question: Can an RHC/FQHC provide patient care services at temporary locations?

Answer: Yes. During the COVID-19 PHE, CMS is allowing currently approved RHCs/FQHCs to provide patient care services in temporary expansion sites to help address the urgent need for supplementary care. These temporary sites are not restricted to the rural/shortage area location requirements. Each location is obligated to follow RHC/FQHC regulations to the extent not waived. Therefore, the RHC/FQHC may provide services provided at a temporary location under the CMS Certification Number (CCN) for the permanent location. The RHC/FQHC is expected to be operating in a manner not inconsistent with its state’s emergency preparedness plan. Note: FQHCs must also have an updated Health Resource and Service Administration (HRSA) Notice of Award, expanding the scope of service to include the temporary location(s) to support response to the COVID-19 PHE.

42.Question:
Do these flexibilities apply to temporary locations established in a parking lot?
Answer: Yes. During the COVID-19 PHE, CMS is allowing RHC/FQHCs to establish temporary expansion sites in a parking lot; either on or off its premises. As with other temporary expansion locations, the parking lot site must meet the same RHC/FQHC regulations as the main site, unless otherwise waived. Therefore, the RHC/FQHC may provide for those services via the existing CCN of its approved permanent location. RHC/FQHC is expected to be operating in a manner not inconsistent with its state’s emergency preparedness plan.
43.Question:
Can an RHC/FQHC provide patient care services to a patient in the patient’s vehicle?
Response:During the COVID-19 PHE, to help minimize transmission, an RHC/FQHC visit can take place if the patient is in a vehicle on the premises of the RHC/FQHC and all requirements for a billable visit are met (e.g. medically-necessary, face-to-face visits with an RHC/FQHC practitioner). The RHC/FQHC would provide the services using its existing CCN. All services provided are held to all RHC/FQHC regulations, unless otherwise waived. This includes, but is not limited to, the provisions of services as per 42 CFR 491.9(c). RHCs/FQHCs must consider the clinical appropriateness of services before conducting a visit and/or treating a patient in their vehicle.
44.Question:
Will a RHC or FQHC seeking approval of its temporary location as being consistent with the emergency response and pandemic plan be provided with evidence of approval or denial from the state?
Answer: State emergency plans and processes will vary. RHCs/FQHCs should retain any communications with the State emergency preparedness representatives to demonstrate that its temporary location(s) are not inconsistent with the state emergency preparedness and pandemic plan for the COVID-19 PHE. Once the state has approved the addition of temporary location(s), there are no additional CMS enrollment or reporting requirements. The RHC/FQHC may begin utilizing the temporary expansion location throughout the duration of the COVID-19 PHE.
45.Question:
May an RHC or FQHC continue providing RHC/FQHC services at the temporary location once the COVID-19 PHE ends?
Answer: No. All waived CoPs, CfCs, requirements, and most temporarily revised regulations will terminate at the end of the PHE. If the RHC/FQHC wishes to continue services at the temporary expansion location after the PHE has ended, the facility must submit form 855A to begin the process of enrollment and initial certification as a RHC or FQHC under the regular process and meet all applicable requirements, including 42 CFR 491.5.
46.Question:

My RHC participates in Medicare through one of the two CMS-approved RHC Accreditation Organizations (AOs). Do waivers of CMS regulations apply to CMS-approved accrediting programs? Do I need to notify the AO of my desire to temporarily add a service location during the COVID-19 PHE?

Answer: The flexibilities apply to both accredited and non-accredited RHCs. Notifying your AO of the temporary location is recommended.
47.Question:
Where can I find answers to COVID-19 flexibilities regarding Medicare Fee-for-Service (FFS) billing for RHCs and FQHCs?

Answer: To assist RHCs and FQHCs in furnishing service during the COVID-19 PHE, CMS has provided additional flexibilities related to billing for services. These temporary flexibilities currently include Expansion of Virtual Communication Services for RHCs and FQHCs to include online digital evaluation and management services using patient portals, and Revision of Home Health Agency Shortage Area Requirement for Visiting Nursing Services Furnished by RHCs and FQHCs. Please see the Medicare FFS Billing FAQ document available at https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf. Please see Section II.L of the Interim Final Rule with Comment Period, “Medicare and Expanded Flexibilities for Rural Health Clinics (RHCs) Medicaid Programs; Policy and Federally Qualified Health Centers (FQHCs) During Regulatory Revisions in Response to the COVID-–19 Public Health Emergency (PHE)”(85 FR 19230, 19253), available at https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public, for more information on regulatory changes for RHCs and FQHCs.


Webinar info:  How to prevent infectious diseases and the spread of infectious diseases in ICF-Specifically COVID-19 (May 27th, 2020)

See the following pdf link from HHSC

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/icfiid-covid-updates-qa-webinar-may-27-2020.pdf


March 13th ICF FAQ’s  See link below:

Survey Operations Resume as of June 15th, 2020

From HHSC
As of June 15, 2020, Survey Operations has begun to resume some normal survey activity, and Enforcement is also resuming enforcement processes and activities. This means we will be issuing various due process notice letters to individuals, agencies, and facilities that have been on hold due to COVID.
Please contact Enforcement Director Derek Jakovich by email at derek.jakovich@hhsc.state.tx.us if you have questions.
In response to questions regarding what normal survey and enforcement activities are resuming as of June 15 and what programs are affected, HHSC replied as follows:
As of June 15, 2020 Survey Operations is resuming some survey activity such as complaints with lower priorities, and possibly some licensure and certification surveys. For Enforcement, due process notice letters such as denials, revocations, and imposition of administrative penalties will be issued and the opportunity to appeal will be provided. Of course, the COVID circumstances may affect these activities.
The notice applies to NF, ALF, DAHS, PPECC, HCSSA, and ICF/IID.

Providers Must Log Residents’ Leave

All community-based ICF/IID program providers must submit an absence request in the TMHP ICF/IID Online Portal for a resident away from the facility for one or more full days. See the TMHP ICF/IID Online Portal User Guide (PDF) starting on page 52 for more information. The program provider must submit a return request within three days after a resident returns to the facility. See page 58 of the Online Portal User Guide for an explanation.

Please ensure that information entered in the portal for absences is current. HHSC uses the information to determine how many residents are absent from their facilities and the length of those absences.

 

Contact Information
If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at

PolicyRulesTraining@hhsc.state.tx.us or call (512) 438-3161.


Provider Joint Training Opportunities

Check out Joint Provider Trainings link from HHSC, for more info:
https://apps.hhs.texas.gov/providers/training/jointtraining.cfm#course_112

 


Survey Process for ICF Has Changed: Please Be Aware

You may check your SOMA (Surveyor’s Operational Manual for ICF in Appendix J) for these changes.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_j_intermcare.pdf 

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R178SOMA.pdf


Appendix Q of SOMA (Immediate Jeopardy) Changes

http://www.tmhp.com/News_Items/2019/04-Apr/CMS%20Releases%20Revision%20to%20Appendix%20Q%20Immediate%20Jeopardy%20Guidelines.pdf

CMS clarifications letter

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-09-ALL.pdf

Online basic training for Core Appendix Q is available on the Integrated Surveyor Training
Website at the following link:https://surveyortraining.cms.hhs.gov/
This basic training is intended to provide Regional Office and State Survey Agency surveyors, management staff, and
training coordinators, as well as providers, suppliers, and laboratories, and other stakeholders with
the ability to identify immediate jeopardy
.
NOTE: This is a required training for RO and SA staff involved in immediate jeopardy
determinations. All RO and SA surveyors, members of management, and training coordinators
are expected to take this training as soon as practicable, but not later than March 22, 2019.
Point of Contact:
For questions related to this information, please add in subject line
“Immediate Jeopardy Inquiry” and send your email to:
QSOG_GeneralInquiries@cms.hhs.gov  
.
Effective Date:
Immediately-This policy should be communicated to all survey and certification staff, their managers and the State
and Regional Office training coordinators within 30 days of this memorandum.

 

SOMA appendix Q Section  Immediate Jeopardy 

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_q_immedjeopardy.pdf


II.  Proposed ICF/IID Rates: Below please find the link to information about the August 2, 2019 HHSC public hearing on the proposed ICF/IID rates.  The hearing will be at 3:00 p.m. and held in the HHSC public hearing room (first floor of HHSC).  Additional information about the hearing (specifically, needed member action) will be forthcoming.
Though the above link provides the proposed rates, below is a chart which reflects both the current and proposed ICF/IID rates.  Note that with the exception of LON 9, all LON categories and facility settings/sizes are proposed to receive an increase.  Also, at this time, the specifics regarding the impact of the increases on the rate categories (residential direct and indirect  & day habilitation direct and indirect) are not yet available.  According to HHSC the ‘specifics’ should be available on or after this Friday (July 19, 2019).

LON & Facility Size

Current Rates

Proposed Rates

SMALL

 

 

LON 1

$144.25

$150.31

LON 5

$160.74

$167.90

LON 8

$182.82

$191.85

LON 6

$223.88

$236.59

LON 9

$406.11

N/C

MEDIUM

 

 

LON 1

$118.04

$123.14

LON 5

$134.06

$140.24

LON 8

$158.90

$166.92

LON 6

$190.24

$200.79

LON 9

$385.84

N/C

LARGE

 

 

LON 1

$112.09

$116.30

LON 5

$119.64

$124.64

LON 8

$133.22

$139.44

LON 6

$179.40

$188.96

LON 9

$387.25

N/C

 

 

COVID-19 Information

November 22, 2020

COVID-19 Guidance for Activities, Dining, and Volunteers for the Holidays (PL 20-53)

HHSC publishes Provider Letter 20-53 Guidance for Activities, Dining, and Volunteers (PDF). The letter outlines provider responsibilities for resident activities, including communal dining and holiday-related activities.

The letter also gives specific stipulations on the use of volunteers and guidance on the protocol for residents who leave a facility.

This guidance can be used as a general reference through the duration of the COVID-19 pandemic.

 

HHSC Issues Guidance to HCS/TxHmL Providers on Covid-19!!!!

July 27, 2020

HHSC Long-term Care Regulation has updated the COVID-19 Response Plan for HCS residential providers (PDF). The document provides guidance on response actions in the event of a COVID-19 exposure.

Provider Letter 20-12, HHSC Guidance to HCBS and TxHmL Program Providers on Covid-19, is now available. HHSC encourages program providers to review this guidance. Remember, no non-essential visitors, see definition in the letter and providers must refrain from sending individuals to Day Habilitation and Community Events!  See link below.

https://hhs.texas.gov/about-hhs/communications-events/news/2020/03/hhsc-issues-guidance-hcs-txhml-providers-covid-19

July 28th, 2020      COVID-19 Update For Group Homes- HCS/ICF

The three IDD associations met with HHSC met on 7/28/20 to discuss ongoing COVID-related matters.  A summary of the discussions is presented below.  In reviewing please know that due to time constraints, not all agenda items were able to be discussed.  HHSC will provide the associations with a written update on these items by close of business on July 29, 2020.
 
These are 2 major concerns discussed along with the clarifications about those concerns relayed by HHSC.
1.  Regulatory Staff Entering Group Homes When Screening Requirements are not Met (in particular temperature requirements): Based on provider reports from some regions across the state, the 3 IDD associations requested this item be discussed. In response to these reports, HHSC Regulatory stated that no ICF/IID or HCS surveyor (or other persons) should be admitted into a group home if they do not pass screening requirements, and Regional Program Directors should not intervene (as reported in at least one case) by telling providers they have to let them in.  Before denying admission, however, providers should retake a surveyor’s temperature to rule out any misread of or error in the initial taking of one’s temperature.  Also, surveyors should not be wearing/using the same PPE as they go from home to home. They are required to change PPE prior to each home visit.  Persons experiencing issues with either of these matters are encouraged to contact:
Alyssa Naugle (WS&C) –  Alyssa.Naugle@hhsc.state.tx.us –  or
Renee Blanch-Haley (ICF/IID) –  renee.blanch-haley@hhsc.state.tx.us
2.  In-Home Visits by Guardians:  IDD association representatives discussed issues providers are facing with some guardians (whether ‘professional’ or family member guardians) becoming more insistent about wanting to enter group homes.  It was reported that, in some cases, guardians are just entering the homes or telling direct support staff that they have the  ‘right’ or the ‘authority’ to be in the homes, making it difficult at times for direct support staff to counter.  While all acknowledge the strain current visitor restriction policies place on individuals, guardians and other family members, HHSC encouraged providers and staff to remind guardians and other family members of the current in-home visitation restrictions and the other options available (such as virtual visits, outside visits with appropriate social distancing, etc.) for communicating and visiting with their loved ones.  HHSC added that providers should document these events. 

Reminder to LTC Facilities about Death Reporting Requirements

July 22, 2020

The following are HHSC’s requirements for care facilities to report resident/individuals’deaths to HHSC, including deaths from COVID-19.

  • Intermediate care facilities must report all deaths to Complaint and Incident Intake within one hour. See:
  • Home and Community-based Services and Texas Home Living Program Providers must report all deaths of people receiving HCS or TxHmL services to HHSC by the end of the next business day following the death or the program provider’s learning of the death. See IL 12-28.

***Note: If the death may have been from abuse, neglect or exploitation, more reporting requirements may exist.

 

PUBLIC HEALTH EMERGENCY EXTENDED FOR 90 DAYS
The COVID-related public health emergency, which was set to expire July 25, 2020,  has been extended for 90 days (through the end of October 2020).

COVID-19 HCS Interest List Reduction and Promoting Independence Slot Releases 

Information letter (IL) 2020-27 was released to provide updated information on Home and Community-based Services and Local Intellectual and Developmental Disability Authorities. It replaces IL 20-15, COVID-19 HCS Interest List Reduction Slots, previously issued on April 9 and revised on April 23, 2020.

HHSC is resuming the release of HCS Interest List Reduction Slots starting June 1, 2020. HHSC is continuing releases of HCS Promoting Independence Slots. LIDDAs will request the following HCS Promoting Independence Slots:

  • Crisis diversion
  • Nursing facility diversion
  • Young adults aging out of foster care
  • Nursing facility transition
  • Nursing facility transition for children
  • SSLC transition

 

The weekly webinars for Medicaid CHIP COVID-19 Information have been canceled and instead, HHSC will be providing a post to a  pre-recorded session online for viewing at your convenience to reduce the potential for technical difficulties. These information sessions will continue to share information about the actions taken to implement various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic. HHSC will continue to work on additional flexibilities across the programs and will update stakeholders each week on new implementations and issued guidance. Links to each week’s information session will be posted on the HHS COVID-19 Medicaid & CHIP webpage (https://hhs.texas.gov/services/health/coronavirus-covid-19/medicaid-chip-services-information-providers) by 1:00 p.m. CT on April 16, and each Thursday going forward.


LTC Providers Required to Report COVID-19 to HHSC

Effective immediately, a provider must report every confirmed case (only confirmed cases) of COVID-19 in staff and individuals receiving services from the provider as a self-reported incident. A presumptive or confirmed case is considered a critical incident.

Providers (other than HCS and TxHmL providers) must notify HHSC through TULIP or by calling Complaint and Incident Intake (CII) at         1-800-458-9858.

HCS and TxHmL providers must notify HHSC at waiversurvey.certification@hhsc.state.tx.us

Though not stated in the message below, in accordance with the April 8, 2020 HHSC COVID-19 HCS/TxHmL webinar, HCS and TxHmL providers are to include the following information when reporting confirmed COVID-19 cases to  waiver, survey and certification: 
~  Provider Name
~  Component Code
~  Contract #
~  Point of Contact Name and Contact Information
~  Individuals:  Name & CARE ID; Number at home; and Number in hospital
~  Number of Staff
 
Report Only Confirmed COVID-19 Cases to HHSC
Providers report only confirmed cases of COVID-19 in staff and individuals receiving services from the provider as a self-reported incident. This is effective immediately. Providers, other than HCS and TxHmL providers, must notify HHSC through TULIP or by calling Complaint and Incident Intake at 800-458-9858. 
HHSC previously required reporting of both presumptive and confirmed cases of COVID-19.
Providers are also required to report communicable diseases to the health authority with jurisdiction over their facility (LOCAL HEALTH DEPT.) This is in accordance with the Communicable Disease and Prevention Act, Texas Health and Safety Code, Chapter 81. It’s also specified in Title 25 of the Texas Administrative Code, Chapter 97.

List of Local Health Authorities for COVID-19 from DSHS

https://www.dshs.texas.gov/regions/Coronavirus-(2019-nCoV)-Local-Health-Entities/

See Link below to handout on the role of the Local Health Authorities 

https://www.dshs.state.tx.us/region1/documents/tmp-LocalHealthAuthority.pdf 

 

Obtaining an HHSC Letter Requesting a Store Waiver for Product

Purchase Limits  

An HCS program provider operating a three or four-person residence may request a letter from HHSC requesting that a store waive product purchase limits for food and personal care items implemented because of the COVID-19 crisis.

Send letter requests to the HCS Policy inbox at HCSPolicy@hhsc.state.tx.us.

Include:

  • HCS program provider name
  • Number of the contract the program provider has with HHSC
  • Address of the three-person or four-person residence
  • Location code of the residence
  • Program provider tax ID.

HHSC will review the CARE and verify the information in the request. Then, HHSC will email a letter to the HCS program provider requesting that a store waive product purchase limits for food and personal care items because of the COVID-19 crisis. Program providers can only use the letter when purchasing such items for a three or four-person residence.

Even though a store is given the letter, it may choose not to waive the purchase limit for the program provider. A program provider can reprint the emailed letter

 

 

 

FAQ’s For Covid-19

04/02/20

From Stakeholder’s Meetings March 16th-31st  (Draft)

 

Contact Information For Other Questions:

 

Can individuals eat meals together?

Answer: As stated in PL 20-22, HHSC recommends canceling communal dining, however, HHSC is not prohibiting individuals in a three-person, four-person, or host home/companion care residence from dining together. HHSC recommends that if individuals dine together, staff members help ensure that the individuals practice social distancing at the dining table. HHSC also recommends that staff members plate the individuals’ food and help ensure they do not share serving spoons, utensils, plates, cups, or other related items.

Do local shelter-in-place orders prohibit an individual from leaving and returning to the home?

Answer: Shelter-in-place orders issued by local governments may vary, but in many instances require individuals to stay home unless they need to take care of a medical-related issue, go to the grocery store, or exercise outdoors while practicing social distancing. Many also require non-essential businesses to close. They do not prevent persons from returning to their residence. Program providers will need to comply with the restrictions and orders issued by their local government. Departures that are not health-related are strongly discouraged, and HHSC recommends that if an individual chooses to temporarily leave a three-person, four-person, or host home/companion care residence, the individual be allowed to return to the residence. If an individual leaves a residence temporarily for any reason, the individual must be screened upon return. If the individual meets any of the screening criteria described on page 2 of PL 20-22, HHSC recommends that the program provider isolate that individual in one area of the residence to protect other individuals in the residence.

Can providers tell people not to return for a period of time after vacation, home visit, etc.?

Answer: HHSC recommends that a program provider advise an individual of any local social distancing requirements, public gathering restrictions, or shelter-in-place orders. Departures that are not health related are strongly discouraged, and HHSC also recommends that if an individual chooses to temporarily leave a three-person or four-person residence or residence in which host home/companion care is provided, the individual be allowed to return to the residence. If an individual leaves a residence temporarily for any reason, the individual must be screened upon return. If the individual meets any of the screening criteria listed on page 2 of PL 20-22, HHSC recommends that the program provider isolate that individual in one area of the residence to protect other individuals in the residence.

What signage should be posted at the entrance of a home?

Answer: HHSC’s recommendations about signage at a three-person or four-person residence or a residence in which host home/companion care is provided are addressed on page 3 of PL 20-22.

If there is a fire or an emergency medical situation, do emergency responders need to be screened before entering a home?

Answer: Three-person, four-person or host home/companion care homes should not require screening of emergency services personnel in the event of an emergency.

Who is expected to screen PAS/HAB staff at an own home or family home?

Answer: HHSC does not have requirements governing the screening of these staff before they enter an individual’s own home or family home. HHSC recommends that the program provider assist the individual or the individual’s family members in monitoring the health of CFC PAS/HAB service providers as much as possible.

Are individuals required to continue receiving all services, or will there be exceptions for non-essential services?

Answer: As stated in PL-20-22, program providers are required to ensure that an individual’s critical needs are met. HHSC is not prohibiting the provision of non-critical services to individuals; however, providers must comply with any social distancing requirements, public gathering restrictions, or shelter-in-place orders issued by local governments. Providers can arrange for non-critical services to be delivered to an individual through a method other than an in-person visit to a health care professional, such as by telephone, Skype etc.

Can providers suspend routine doctor visits/therapy visits and/or use electronic visits instead?

Answer: Program providers can reschedule appointments for non-critical services, including routine doctor and therapy visits, or arrange for those services to be delivered through a method other than an in-person visit, such as by telephone, Skype etc.

Are individuals allowed to attend day hab if they want to attend?

Answer: HHSC has issued IL 20-09, which explains changes to allow day habilitation to be provided in the home. HHSC recommends program providers protect individuals by refraining from attending day habilitation, and events in public where more than 10 people are gathered. HHSC is not prohibiting the provision of non-critical services to individuals, which might include day habilitation. However, program providers must comply with any social distancing requirements, public gathering restrictions, or shelter-in-place orders issued by local governments.

Can providers bill for in-home day habilitation for host home companion care? If so, when?

Answer: HHSC has issued IL 20-09, which explains changes to billing requirements for the provision of day habilitation in an individual’s residence.

I have staff who have called in sick and simply can no longer work due to child care issues. What do I do when there are not enough staff for coverage?

Answer: As stated in PL-20-22, program providers are required to staff homes and ensure that an individual’s critical needs are met.

We have quite a few service recipients working. The guidance calls for limiting visitors but does not speak to whether providers should try to keep people home from work. What do we do?

Answer: HHSC recommends that a program provider advise an individual of any local social distancing requirements, public gathering restrictions, or shelter-in-place orders. Further, if an individual chooses to leave a three-person, four-person, or host home/companion care residence to work, HHSC recommends the individual be allowed to return to the residence but be screened upon the return. If the individual meets any of the screening criteria described on page 2 of PL 20-22, HHSC recommends that the provider isolate the individual in one area of the residence to protect other individuals in the residence.

How do HCS and TxHmL program providers get personal protective equipment (PPE)?

Answer: Program providers can contact the following organizations to ask about obtaining PPE:

  • State of Texas Assistance Request (STAR)

https://olympus.soc.texas.gov/files/docs/StarGuides/2020_STAR_SOC_QuickReference_Guide.pdf

  • Public Health Region

https://www.dshs.state.tx.us/regions/default.shtm

  • Local Public Health Organizations

https://www.dshs.state.tx.us/regions/lhds.shtm

  • Texas Division of Emergency Management:

https://tdem.texas.gov/

  • Regional Advisory Councils

https://dshs.texas.gov/emstraumasystems/etrarac.shtm

Where do HCS and TxHmL program providers go for COVID-19 information?

Answer: Reliable sources of information include:

  • The Centers for Disease Control and Prevention
  • The Texas Department of State Health Services
  • The Health and Human Services Commission

Who do I call if staff or individual tests positive for COVID-19?

Answer: Contact the local health department, or the Department of State Health Services (DSHS) if there is no local health department. Additionally, program providers must also report this information to HHSC at:waiversurvey.certification@hhsc.state.tx.us

HHS 3 Line Logo

ICF COVID-19 Info from HHSC

April 13, 2020

A recording of the April 9, 2020, ICF/IID COVID-19 Q&A with HHSC LTC Regulatory and DSHS is now available. It’s for those who could not attend the webinar.

View the COVID-19 Q&A recording here.

TCDD
The Texas Council for Developmental Disabilities (TCDD) is seeking stories about the impact of COVID-19 on persons with disabilities.  The information will be used to inform state agencies, legislators and other state leaders about the needs of the ID/DD population as they make critical decisions regarding policy and funding related to this crisis.
We encourage you to share this information with persons you serve and their families. 
To access details about this TCDD initiative, go to:  https://tcdd.texas.gov/resources/covid-19-information/texas-covid-stories/

HHS 3 Line Logo

New Guidance for LTCR Providers on Coronavirus

LTCR urges all providers to review the Centers for Disease Control’s new guidance on strategies to prevent the spread of COVID-19 in long-term care facilities. To ensure you have the most current information on COVID-19, visit the CDC and DSHS websites. For questions or guidance, call one of the DSHS hotlines:

  • 888-963-7111
  • 877-570-9779

All providers must continue to follow all laws, regulations, guidance and their own internal policies and procedures related to infection control.

 

From The CDC website:

Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs)

COVID-19 cases have been reported in all 50 states, the District of Columbia, and multiple U.S. territories; many having wide-spread community transmission. Given the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death.

  1. Keep COVID-19 from entering your facility:
    • Restrict all visitors except for compassionate care situations (e.g., end-of- life).
    • Restrict all volunteers and non-essential healthcare personnel (HCP), including consultant services (e.g., barber, hairdresser).
    • Implement universal use of source control for everyone in the facility.
    • Actively screen anyone entering the building (HCP, ancillary staff, vendors, consultants) for fever and symptoms of COVID-19 before starting each shift; send ill personnel home. Sick leave policies should be flexible and non-punitive.
    • Cancel all field trips outside of the facility.
  1. Identify infections early:
    • Actively screen all residents daily for fever and symptoms of COVID-19; if symptomatic, immediately isolate and implement appropriate Transmission-Based Precautions.
      • Older adults with COVID-19 may not show typical symptoms such as fever or respiratory symptoms. Atypical symptoms may include new or worsening malaise, new dizziness, or diarrhea. Identification of these symptoms should prompt isolation and further evaluation for COVID-19.
    • Notify your state or local health department immediately (<24 hours) if these occur:
      • Severe respiratory infection causing hospitalization or sudden death
      • Clusters (≥3 residents and/or HCP) of respiratory infection
      • Individuals with suspected or confirmed COVID-19
  1. Prevent spread of COVID-19:
    • Actions to take now:
      • Cancel all group activities and communal dining.
      • Enforce social distancing among residents.
      • Ensure all residents wear a cloth face covering for source control whenever they leave their room or are around others, including whenever they leave the facility for essential medical appointments.
      • Ensure all HCP wear a facemask or cloth face covering for source control while in the facility. Cloth face coverings are not considered personal protective equipment (PPE) because their capability to protect healthcare personnel (HCP) is unknown. Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is required.
    • If COVID-19 is identified in the facility, restrict all residents to their rooms and have HCP wear all recommended PPE for care of all residents (regardless of symptoms) on the affected unit (or facility-wide depending on the situation). This includes: an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and gown. HCP should be trained on PPE use including putting it on and taking it off.
      • This approach is recommended because of the high risk of unrecognized infection among residents. Recent experience suggests that a substantial proportion of residents could have COVID-19 without reporting symptoms or before symptoms develop.
      • When a case is identified, public health can help inform decisions about testing asymptomatic residents on the unit or in the facility.
  1. Assess supply of personal protective equipment (PPE) and initiate measures to optimize current supply:
    • If you anticipate or are experiencing PPE shortages, reach out to your state/local health department who can engage your local healthcare coalition.
    • Consider extended use of respirators, facemasks, and eye protection or prioritization of gowns for certain resident care activities.
  1. Identify and manage severe illness:
    • Designate a location to care for residents with suspected or confirmed COVID-19, separate from other residents.
    • Monitor ill residents (including documentation of temperature and oxygen saturation) at least 3 times daily to quickly identify residents who require transfer to a higher level of care.

Pre-Webinar Survey For: “Round Table Discussion For Nursing Concerns In IDD Programs” (HCS/TxHmL/ICF)

Pre-Webinar Survey

For those Nurses registered or planning to register for our Dec 11th, 2020 follow-up session:                                                                                      “Round Table Discussion For Nursing Concerns In IDD Programs” (HCS/TxHmL/ICF)

We did not get to at least 4 of our questions primarily on COVID during the 1st Round Table Discussion on 11/5/20.  We still have some questions on RN Delegations that we need feedback on for future sessions and COVID-19.  We felt they were very important and did not want to wait until the Feb. quarterly session.  Thanks.
Please print out this page and document your answers and responses to help us to develop topics of discussion during our 1st session as well as future round table sessions.
You will need to scan your completed survey and email them as soon as possible, but by no later than 12/08/20, to info@twogetherconsulting.com or you may also submit them when you complete your registration prior to 11/1/20 to Meghan Jones.  Her email is:  meghanjones.tx@gmail.com if you prefer.  You do not have to put your name on the survey!   You can also fax them to 512-291-9075

Survey:

Short Nurse input: Please let us know what you are hoping this forum achieves for you specifically;
(in a few short words)

Survey Questions:  

Points to Ponder
“The National Developmental Disabilities Nurses Association categorizes the responsibilities of IDD nurses as fitting into eleven categories”: Our present focus today is to develop input from the nurses as it relates to delegation and assignment:
“The responsibilities of delegation and authority contribute to the ambiguous role of the IDD nurse. Delegation is the process by which responsibility and authority for performing a task are transferred to another individual. In the delegation process, the delegator remains accountable for the task that has been delegated. However, in many settings, the IDD nurse does not have supervisory authority over the unlicensed direct support staff who provide much of the hands-on day to day care of people
with IDD.”

 

1. Does your employer possess a basic understanding of RN delegation responsibility and practice guidelines, and acknowledge your role in the delegation decision-making process?
a. Yes, my employer is supportive & knowledgeable in the basic delegation decision process
b. I am assigned delegations and there is not a cohesive framework or systematic process
c. I believe that the Program Manager, Case Manager, and UAP are willing to learn from the RN and improve basic
knowledge as well as move towards an educational and systematic approach to safe RN Delegation processes.

ANA Quote
“The American Nurses Association describes unlicensed support staff as individuals trained to function in an assistive role to the registered nurse. Without supervisory authority, IDD nurses have little opportunity to intervene when necessary to ensure safe and appropriate healthcare. This inability to practice to the full extent of licensure can lead to frustration for the IDD nurse”.

2. Do you have supervisory authority and do you understand the scope of your delegation authority: (i.e. input on related policies, recommendations for UAP’s, concerns with repetitive medication errors, or lack of correct implementation by UAP related to delegated tasks performed in accordance with protocols).
a. Yes
b. No

Describe your input on a solution (if you are an RN):

 

c. N/A  (Not an RN)

3. TRUE OR FALSE (circle one)
I find that the rules are fragmented and regulations may be misunderstood and standardized nursing practice is difficult to achieve.

 

4. TRUE or FALSE (circle one)
Covid 19 Processes: we have processes in place. We are following CDC guidelines, and I am clear on the established Policies and Protocols that are mandated.

If you answered “false” to this question briefly describe your needs:  (i.e. -education, sample policies, etc…)

 

COVID-19 – “Food For Thought”:  There are a lot of considerations and concerns in the workplace for Providers of IDD services, in particular nurses as well as staff. Has protocol and training been developed, implemented and how are we monitoring this?  How can we do this effectively?  Other questions like: Is this protocol actually occurring?  Is it being implemented correctly by nurses and staff?  In addition, are we ensuring we are following the most ethical standards and considering the feelings, mental state and concerns of our individuals?  Are we taking into proper consideration the safety of our own family members in our daily protocol, for when we come and go from the facility?  Are we trying to mitigate COVID-19 in every way possible?  Is “burn out” happening with ourselves or our staff and what can we do to prevent it?

5.  Do you feel isolated as a nurse, during the pandemic at your work?

a. Yes    b. No

If you answered “yes”, please comment:  (i.e. In what way do you feel isolated in the workplace?)

Comment:

 

6.  Do you feel “burn out” yourself or among your fellow nursing staff?

a. Yes    b. No

If you answered “yes”, what do you think we might be able to do about it?  (Or ways facility might be able to help manage it?)

Comment:  

 

7: What obligation do you think you have to yourself and/or your family (while in the workplace during the pandemic)?

Comment:

 

 

 

EVV (Electronic Visit Verification) Updates

HCS and TxHmL Program Providers Required to Select an EVV Vendor
NEW LOGO - SMALLER
Blue Gradient

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!!

October 21, 2020

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.


 

 

 

Clarification: No EVV For In-Home DH (3 & 4-bed Homes or Host Homes)
September 11, 2020

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

HCS/TxHmL

Additional Training Opportunities

Program providers and FMSAs can also meet training requirements by completing computer-based training online in the HHSC Learning Portal and TMHP Learning Management System. HHSC and TMHP are planning additional live training events this fall and will provide more information when available.

Email TMHP for questions about registration or the EVV Portal.

Email questions about EVV training requirements.

 For more Cures Act information, visit the HHS EVV Cures Act webpage.


 

If you miss the EVV training dates, you may take them on the HHSC learning portal:

https://learningportal.dfps.state.tx.us/


 

Please go to HHSC’s page on Electronic Visit Verification for the latest information/ updates to EVV.  Please see Training & Joint Training pages from HHSC as well!

https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/electronic-visit-verification


Updated Timeline for Cures Act EVV Expansion     

The updated timeline for expanding the Cures Act EVV requirement to all Medicaid personal care services is now available on the HHS Cures Act EVV website.

The timeline includes new information and resources about the EVV Practice Period beginning July 1, completing training requirements, and more.

This information is for Cures Act program providers and FMSAs (PDF) required to use Electronic Visit Verification by Jan. 1, 2021.

For questions, contact EVV.



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


Trainings Available:

EVV Policy Training (Provided by your payer)

  • The HHSC EVV Policy computer-based training (CBT).
  • The MCO Policy training. Contact your MCO for EVV Policy training opportunities.

EVV Aggregator and EVV Portal Training (Provided by TMHP)

There will also be instructor-led trainings (EVV Roadshow) in October. Find the schedule and register on the HHS Learning Portal.

Additional training resources are available on the HHSC EVV website and the TMHP EVV Provider Training webpage.

For questions about this alert, email Electronic_Visit_Verification@hhsc.state.tx.us.

 

Online, interactive EVV training courses are available

in the HHS Learning Portal and TMHP Learning Management System. Completing these courses help program providers meet EVV training requirements.

The HHS Learning Portal includes training about HHSC EVV Policy.

The TMHP Learning Management System includes training about:

  • EVV Vendor Selection
  • EVV Portal
  • EVV Portal Standard Reports and Search Tools
  • EVV Claims Submission and Billing

Very Important HHSC Alerts!

November 22nd, 2020

COVID-19 Guidance for Activities, Dining, and Volunteers for the Holidays (PL 20-53)

HHSC publishes Provider Letter 20-53 Guidance for Activities, Dining, and Volunteers (PDF). The letter outlines provider responsibilities for resident activities, including communal dining and holiday-related activities.

The letter also gives specific stipulations on the use of volunteers and guidance on the protocol for residents who leave a facility.

This guidance can be used as a general reference through the duration of the COVID-19 pandemic.


November 22, 2020

HCS Training Webinars on the TAC Principals for November 2020

https://hhs.texas.gov/about-hhs/communications-events/news/2020/10/november-hcs-provider-certification-principle-webinars

Future topics:
9.178 Quality Assurance
9.173 Rights of Individuals
9.174 Service Delivery
9.181 and 9.182 Administrative Penalties and Amelioration

 

October 11th, 2020

IPC COVID-19 Policy Guidance for CLASS, DBMD, HCS and TxHmL Programs         

HHSC is not requiring a face-to-face meeting with an individual or their legally authorized representative for individual plan of care revisions. This is per COVID-19 guidance IL-20-11.

In addition, until further notice by HHSC, signatures from the individual or the LAR on the IPC or supporting documentation is not required before submitting to HHSC.

All required signatories that are not the individual or LAR (SC and Provider Representative) must sign the IPC and supporting documentation before submission.

For meetings currently conducted by phone or videoconference to revise an IPC, required individual or LAR signatures on the IPC and supporting documentation can be done electronically, by fax, by mail, or in person if face-to-face restrictions have been lifted and it is safe to do so. If unable to obtain a signature by the methods mentioned, document the following:

  • The date of the meeting held by phone or videoconference
  • The reason for the meeting and what was discussed
  • If the individual or LAR agree with the services as indicated on the revised IPC

September 30th, 2020

Information Letter No. 20-42

Residential Services During COVID-19

HHSC has been informed that some individuals living in a three-person or four-person residence are temporarily staying with family during the COVID-19 public health emergency (PHE). In accordance with the HCS Billing Guidelines, a program provider is unable to bill for residential support or supervised living if an individual is away from a three-person or four-person residence for longer than 14 consecutive days.
HHSC is in the process of seeking approval from the Centers for Medicare and Medicaid Services (CMS) to make retainer payments to HCS program providers during the PHE for residential support and supervised living for up to 90 days an individual is absent from the residence in excess of the 14-consecutive day period. If CMS approves, HHSC will provide information to program providers about billing retainer payments for the period of March 20, 2020, through October 23, 2020, and conditions a program provider must meet to receive the payments. By October 5, 2020, HCS program providers must provide an electronic or hard copy of the attached letter to an individual (or the individual’s legally authorized representative) whose residential location is a three-person or four-person residence and who is temporarily staying with family because of the PHE.
Questions regarding this information letter can be directed to HCSpolicy@hhsc.state.tx.us
The letter to send to the individual and their LAR’s is attached to information letter No-20-42
“…Since you have not received residential services for an extended period during the PHE, to ensure your individual service plan accurately reflects the services you need, you must decide to do one of the following by November 1, 2020
:•return to your three-person residence or four-person residence; or
•change your residential location from “three-person residence” or “four-person residence” to “own home/family home”;or
•change your residential location from “three-person residence” or “four-person residence” to “host home/companion care”
if your provider can contract with a person in your own home or family’s home to deliver the “host home/companion care” service. By November 1, 2020, your program provider will contact you about the decision you have made. If your decision is to change your residential location, the program provider will initiate revisions to your individual plan of care (IPC) and person-directed plan (PDP)…”
For more information and the complete letter to the individual and LAR’s, please see the entire information letter.

September 15th, 2020

Abuse, Neglect, and Exploitation Competency Training and Exam

Now Available in Spanish!!   

HHSC’s Abuse, Neglect and Exploitation Competency Training and Exam is now available in Spanish.

This training is designed to meet the basic ANE training requirements for staff providing direct care in a community setting.

To access the training and exam:

  1. Go to the Texas HHS Learning Portal
  2. Staff members, service providers and volunteers must first sign up on the Learning Portal to access HHSC-approved trainings, if they have not already created an account.
  3. Click “Medicaid Long Term Services and Supports Training” and selectCurso para la prevención del abuso, negligencia y explotación (ANE) to access the ANE training and test in Spanish.

ANE Competency Training & Exam

The training and exam requirements for the following long-term services and supports programs can be found below:

Home and Community-Based Services

TAC §9.175 Certification Principles: Requirements Related to the Abuse, Neglect, and Exploitation of an Individual

HCS Handbook Appendix XII, Abuse, Neglect, and Exploitation Training and Competency Test

Texas Home Living

TAC §9.585 Certification Principles: Requirements Related to the Abuse, Neglect, and Exploitation of an Individual

TxHmL Appendix IX, Abuse, Neglect, and Exploitation Training and Competency Test

Reporting a Death to HHSC in the HCS/TxHmL Programs

September 3rd, 2020

To report a death, HCS/TxHmL providers should complete Form 8493, Notification Regarding a Death in HCS, TxHmL programs by the end of the next business day following the program provider becoming aware of the individual’s death. Then fax the completed form to HHSC to 512-206-3999according to the newest version of form 8493 that was updated in May of 2020.

FYI-The previous fax # was 512-438-4148, which is still noted on the HHSC website as of now.  Please make sure you are faxing to the fax # listed on form 8493.

 

August 10th, 2020

Administrative Penalties Update!

HHSC Postpones the Implementation of Administrative Penalty Rules for HCS and TxHmL Providers

Due to COVID-19, HHCS is delaying the implementation of the administrative penalty rules for HCS and TxHmL providers until January 1, 2021.

If you missed the most recent webinar for Home and Community-based Services and Texas Home Living providers Long-term Care Regulation to discuss questions and answers related to administrative penalties on July 9th, please register to watch recorded session below.

Register for the WSC Q&A Webinar Regarding Administrative Penalties.

If you missed the initial Joint Provider’s webinar on June 25th discussing Administrative Penalties, you may see the webinar recording of the session below. 

June 25, 2020

A recording of June 25, 2020, HCS and TxHmL Joint Provider Training on Administrative Penalty Rules webinar is available for those unable to attend.

View the webinar recording here


June 7th, 2019

Revised: IL20-11 Temporary Guidance Extended Through Oct. 30 for IPC’s & IDRC’s

To ensure people do not experience a gap in services due to the temporary suspension of face to face service coordination visits for COVID-19, the Texas Health and Human Services Commission will extend Intellectual Disability/Related Condition assessments and individual plans of care expiring at the end of June 2020. This is for people enrolled in the Home and Community- based Services Program or the Texas Home Living Program.

HHS revised IL20-11, Extensions of Eligibility and Individual Plan of Care Revisions for Individuals in HCS and TxHmL Due to COVID-19 (PDF). It was previously issued on March 26 and extends the temporary guidance through Oct. 30, 2020.

Call the IDD Program Enrollment Support message line at 512-438-2484 for ID/RC assessment questions.

Call the IDD Utilization Review message line at 512-438-5055 for IPC extension or revision.


Billing Guideline Updates For HCS

November 20, 2019

The HCS, TxHml, and CFC billing guidelines have been updated effective Nov. 15, 2019. A summary of the revisions can be found on page 25 of the CFC PDFpage 147 of the HCS PDF and page 129 of the TxHmL PDF. Send questions about the billing guidelines to HCS.TxHml.BPR@hhsc.state.tx.us.


TAC Updates for HCS

Effective Oct. 1, 2019

Texas Administrative Code has been updated effective Oct. 1, 2019.

Locate program rule updates at 40 TAC Chapter 9 – Home and Community-based Services and Texas Home Living Programs and 40 TAC Chapter 49 Contracting for Community Services.

Send questions about rule updates to hcspolicy@hhsc.state.tx.us or txhmlpolicy@hhsc.state.tx.us and to COS_CFCMTools@hhsc.state.tx.us
for 40 TAC Chapter 49 Contracting for Community Services.

Please pay particular attention to 9.175 (ANE Reporting Rules) in HCS and changes to Tac 9.178 Quality Assurance

Please see the link below to verify the current TAC changes.

https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=9

. Both HCS and TxHmL rules can be accessed here.

Email medical_and_social_services@hhsc.state.tx.us with your questions.


HHSC Launches IDD Operations Portal for HCS, TxHmL, ICF-IID, CFC Non-Waiver Providers and LIDDAs

The Texas Health and Human Services Commission are pleased to announce the implementation of the Intellectual and Developmental Disability Operations Portal. Local Intellectual and Developmental Disability Authorities, Home and Community-based Services, Texas Home Living, Intermediate Care Facility for Individuals with Intellectual Disabilities providers may begin registering to use the IDD Operations Portal starting April 1, 2019.

The IDD Operations Portal is an online system that allows secure submission of electronic documents to and from the IDD Program Eligibility and Support and IDD Utilization Review departments. This portal is not replacing any of the systems you use today, such as TMHP or CARE. It is intended to result in a more timely and efficient submission of documents, and allows providers to check the status of submissions online.

Staggered implementation is happening now. Providers and LIDDAs with DBAs starting with C-G can now register for portal access.

Please see the full implementation schedule detailed in the information letter listed here.

HCS/ICF Provider Job Openings & Job Positions Desired

Based on the many phone calls, emails and contacts through our social media pages concerning Job Positions Desired and Job Openings with HCS providers, I have decided to use our “Updates” page to provide a place where both those persons desiring a position with an HCS Provider and those Posting a Job Position can find each other!

We will not be posting the job description or information on this page directly.  If you contact Meghan Jones at meghanjones.tx@gmail.com and let her know where you are posting a position and who to contact, we can put a link and the contact person’s name, # and/or email.  For example, you are posting on Indeed, Linkedin, BenefitMall, Facebook, PACSTX job postings, an online newspaper, etc…

We will also continue to repost openings when we can on our Linkedin page as well as our Facebook and Instagram pages for Twogether Consulting.

There is no charge, we just ask you all to keep referring us to others who don’t know about us for their HCS business needs and of course we hope you will continue to use our services to assist you with your training needs, on-site and off-site assistance. 

Julie Blacklock/ Owner

 

Current Job Postings (See below)

Down Home Ranch   (Posted 11/16//20)                                                                                                                                                                                                                             (Elgin, Tx)
Position opening:  Part-time LVN
Please go to the following add on Indeed to respond
20250 FM619
Elgin, TX 78621

 

2020 ICF Provider Conference

November 15th, 2020

2020 ICF Provider Conference
Virtual webinars scheduled for November 18, 2020

Top 10 Citations9:30 a.m. to 12:00 p.m. 1.5 hours of CEUs AvailableRegister for the Top 10 Citations Webinar

Register for recorded session below:

https://register.gotowebinar.com/register/3345337105764308238

Infection Control1:00 p.m. to 3:00 p.m.1.5 contact hours of Nursing Continuing Professional Development Available1.5 hours of Continuing Education for Social Workers AvailableRegister for the Infection Control Webinar

Register for recorded session below:

https://register.gotowebinar.com/register/6505906369550667534

Renewals of ID/RC Assessments/ and IPC’s and  Requirements for Revised IPCs and Transfer IPC

10/29/20

IL20-45 Renewals of ID/RC Assessments/ and IPC’s and  Requirements for Revised IPCs and Transfer IPC

This information letter (IL)explains:

-renewal intellectual disability or related condition (ID/RC) assessments and individual plans of care (IPCs) are automatically renewing for one year from the expiration date for ID/RCs and IPCs expiring through December 30, 2020

     -beginning with ID/RCs and IPCs set to expire December 31, 2020, renewal ID/RCs and IPCs will be completed by the provider or service               coordinator before the expiration date;

      -renewal ID/RCs can be completed via telehealth and renewal IPCs can be completed via telehealth or telephone; and

      -continued exception to the requirement that an individual or legally authorized representative (LAR) sign IPC and supporting documentation.          These actions help ensure individuals do not experience a gap in services due to the COVID-19 public health emergency and there is  continued flexibility for limiting face-to-face contact for waiver renewals and service plan revisions.

In addition, if an individual loses waiver eligibility during the PHE, the individual will maintain waiver services

For more information:  Click on this link:  https://apps.hhs.texas.gov/providers/communications/2020/letters/IL2020-45.pdf

ADP Services

 

Our wonderful contact person, Laura Throneberry is, unfortunately, no longer at ADP Payroll.  She has been offered a wonderful new opportunity, and she will greatly miss working with Providers.  You all may be familiar with our other contact, Mitchell Deter.  He will still be assisting providers that work with HCS/TxHmL/and ICF.  Some of you may already be working with him.

Our newest HCS/TxHmL/ICF provider liason is Erin Langlais, who just presented at our free webinar sessions in October of 2020.  She and Mitch were nice enough to give us their time to be part of our free webinar resources for providers.

Erin’s contact info:  907-854-6659 and her email is,erin.langlais@adp.com

Mitchell’s contact info:  803-730-7861  and his email is mitchell.deter@adp.com 

 

 

How is ADP addressing Covid-19 with their clients?  See links below:

Don’t forget if you are trying to develop training and policies around Covid-19, ADP can help!!

https://www.adp.com/about-adp/data-security/client-resources/adp-covid-19-preparedness.aspx

https://www.adp.com/spark/articles/2020/03/covid-19-protecting-your-employees-and-business.aspx

http://chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.adp.com/-/media/who%20we%20are/pdf/business-resiliency-brochure.ashx?la=en&hash=0125A6ECCCF06EDBF9E503030B18EA7023358032

 

EVV 

ADP is now partnering with TSheets, which will be great for our HCS/TxHmL providers who use ADP or who want to use ADP for Payroll and HR support.

Even if you have ADP already and want to upgrade your package, call or email Katie Marx at ADP ( she is Twogether Consulting’s liaison we have been working with) to assist our HCS/TxHmL and ICF providers. I hope this makes it easier for some of you who are concerned about having to get another separate service for Electronic Visit Verification.

Supercharge your ADP Time Cards with T-Sheets!

EVV (Electronic Visit Verification) Tracking

Manage Scheduling

Track Time By The Job

Easy Accurate Time Sheets

Mobile Time Tracking

Who’s Working Now and Where?

Alerts & Approvals

Reports

If you have questions concerning COVID-19  HR concerns: 
  EIDL (Economic Injury Disaster Loans), 
-CARES Act,(Coronavirus Aid, Relief, and Economic Security) and 
-FFCRA (Families First Corona Virus Response Act)  
 
ADP can provide you with assistance as well as with your “Policy & Procedure” needs surrounding COVID-19.  ADP also can provide you with some free resources through ADP, even if you do not currently use ADP Payroll & HR services! 
 
Example:  An employee advocacy center-where employees can call in to see where they can get free testing and set up a telehealth appointment with a real doctor, if you already have health insurance through your business already, a free COVID-19 tool kit for small businesses including a podcast and more to help you. 
They can discuss some other ways ADP can help you as well: other HR issues, staying in compliance and developing a safety manual.
 
 
Please see previous ADP presentations on these topics and more at our Gotostage channel

Please remember to mention how you found out about ADP through “Twogether Consulting/ Julie Blacklock” 

For those of you looking for payroll and HR services for your HCS , TXHmL, and ICF Programs, especially in the Houston and surrounding areas, I urge you to contact Erin Langlais or Mitchell Deter at ADP about these services and more.  These are our main contacts for HCS/TxHmL provider client base in the Austin and Houston area for the most part, and their specific needs.  They do work with providers in other parts of the state as well. They have now also added OIG and LEIE monthly checks to part of the HR services they can provide.  Woo hoo!

ADP can help you with everything from payroll, to employee handbooks for your company, to tracking items due for your HR files, etc… Whether you are new, small, or large business we could all use some help.  At a time when Providers really need to watch every penny, it is nice to also be informed or updated about changes coming!

Some of The Helpful ADP Free Training Webinars & Recordings

 

Title: Workplace Spotlight: COVID-19 Legislative Updates – How the Paycheck Protection Program Flexibility Act (PPPFA) Changed PPP Loan Forgiveness

Duration: 1 hour

Available On Demand

https://event.on24.com/eventRegistration/EventLobbyServlet?target=reg20.jsp&partnerref=web&eventid=2425491&sessionid=1&key=BA14109722A0F3C21600A063428446C4&regTag=&sourcepage=register

Title: How to Create Instant Cash-flow for Small Businesses Leveraging CARES Act and R&D Tax Credits

Duration: 1 hour, 3 minutes

Available On Demand

https://event.on24.com/eventRegistration/EventLobbyServlet?target=reg20.jsp&referrer=https%3A%2F%2Fwww.adp.com%2Fresources%2Fevents.aspx&eventid=2386032&sessionid=1&key=A4098DF17F17CDBB4582C737C4113CA4&regTag=&sourcepage=register

Title: Workplace Spotlight: CARES Act & COVID-19: Understanding the Employee Retention Tax Credit and Other Tax Implications

Duration: 1 hour, 1 minute

Available On Demand

https://event.on24.com/eventRegistration/EventLobbyServlet?target=reg20.jsp&partnerref=web&eventid=2281116&sessionid=1&key=811BF8DD403E27DEC8601E210E210CCD&regTag=&sourcepage=register

Title: SPECIAL EDITION: Protecting Your Workforce and Understanding Policies as Your Organization Responds to COVID-19- Part I

Duration: 35 minutes

Available On Demand

https://event.on24.com/eventRegistration/EventLobbyServlet?target=reg20.jsp&partnerref=web&eventid=2218023&sessionid=1&key=B0D8739554A6735C19B30AA5ECDAE3FD&regTag=&sourcepage=register

Title: SPECIAL EDITION – PART 2: Protecting Your Workforce and Understanding Policies as Your Organization Responds to COVID-19

Duration: 1 hour, 2 minutes

Available On Demand

https://event.on24.com/eventRegistration/EventLobbyServlet?target=reg20.jsp&partnerref=web&eventid=2225067&sessionid=1&key=1E14A512E04471768B1056BB7453393A&regTag=&sourcepage=register

PEO 101: HOW HR OUTSOURCING CAN HELP YOU AND YOUR CLIENTS DURING UNCERTAIN TIMES

Register

Cost Free

CPE Credits1.0 hour

CE Credits0.0 hours

Course Description

During these uncertain times, it is even more important for businesses to have help navigating employee issues like workplace safety, compliance, HR, payroll and employee benefits.  Outsourcing HR through a Professional Employer Organization (PEO) solution is something accounting professionals and their clients can consider for that level of support. Join our panel of CPAs and industry experts as they discuss the most critical elements you need to know about PEOs, from how they work and their benefits to the role they can help play in a crisis so your firm and your clients can both continue moving your business forward.

 

ADPhttps://www.adp.com/

 

 

 

Direct Support Training Resources

College of Direct Support  http://www.directcourseonline.com/direct-support/about/

DirectCourse | “College of Direct Support brings training in line with the latest research and partners with other leaders in the field of Intellectual and Developmental Disabilities”

Has a fantastic training curriculum for Direct Support Staff and their supervisors.  See a list of courses from the 2019 catalog in the link below:

https://www.directcourseonline.com/wp-content/uploads/2019/07/2019-CDS-catalog_Final.pdf

Direct Support Professionals 

From the DSP Perspective: Exploring the Use of Practices That Align With Trauma-Informed Care in Organizations Serving People With Intellectual and Developmental Disabilities
An article in the June 2020 issue of Intellectual and Developmental Disabilities by an author affiliated with Indiana University Bloomington discusses a study that explored the extent to which intellectual and developmental disabilities organizations utilize practices that align with trauma-informed care with their DSP workforce. (abstract free of cost, full-text access available with a fee)

The Impact of Ongoing Staff Development on the Health and Safety of People With Intellectual and Developmental Disabilities
An article published in the Journal of Developmental and Physical Disabilities by an author affiliated with the Council on Quality and Leadership reports on a study exploring how ongoing staff development impacts the health and safety of people with intellectual and developmental disabilities. (abstract free of cost, full-text access available with a fee)

 

Free Online Training at The Center For Start Services:  The  National Leaders in the Mental Health Aspects
of Intellectual and Developmental Disabilities                                                                                                                                                                                                     For all their training go to  https://www.centerforstartservices.org/community-resources

Free Video Training from the NADSP and AADMD  “The Role of The DSP and The Corona Virus”,  Part I-check out this amazing training video.    https://youtu.be/ud4Q4e_hcuw

Part II of this DSP Video Training session is as follows:  “The Role Of The DSP and The Corona Virus” Part II  https://youtu.be/VfErVzMn9-A

Free Training For Those Who Support Persons With IDD

https://hhs.texas.gov/about-hh s/communications-events/news/2017/01/free-training-people-who-support-clients-idd

In-Home Day Habilitation Temporary Policy Changes During COVID-19

HHSC’s information letter (IL) revises IL 20-19, In-Home Day Habilitation Information for Program Providers for COVID-19, previously revised on July 30, 2020, to extend the temporary guidance through November 30, 2020.In response to COVID-19andtoprovide access to needed day habilitation services, the Health and Human Services Commission(HHSC)is temporarily waiving certain requirements in Sections4320and 3710of the HCS Billing Guidelines and the TxHmL Billing Guidelines. Specifically, Section 4320 permits day habilitation to be provided to an individual in the individual’s residence only if justified because of the individual’s medical condition or behavioral issues or because the individual is of retirement age. Section 3710 prohibits one service provider from providing different service components or subcomponents at the same time to the same individuals.
Below are descriptions of the temporary policy changes.
See page two for the current policy under Sections 4320 and 3710. Effective March 13, 2020, through November 30, 2020:
●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 4320. This includes individuals residing in their own homes or family homes.
●HCS program providers may, if an individual in the HCS Program is receiving day habilitation in the individual’s temporary or permanent residence, allow the individual’s service provider of residential support, supervised living, or
●host home/companion care to provide day habilitation to the individual at the same time the service provider provides residential support supervised living, or host home/companion care to the individual.  For more information please read information letter IL 20-19 

COVID-19 Resources

COVID-19 Resources

 

 

https://open.texas.gov/


Texas HHS Home

HHSC COVID-19 Provider Information

https://hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-provider-information


 

Coalition of Texans with Disabilities

https://www.txdisabilities.org/news-events/coronavirus-information-resources


ANCOR’s COVID-19 Resource Center

https://www.ancor.org/covid-19

CDC information for persons with IDD

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-disabilities.html

Resources from HRS

“As the situation with Coronavirus (COVID-19) develops, HRS is committed to providing those who work in the field of IDD supports with practical, sensible, and usable health information regarding identifying those at most risk and steps that can be taken to reduce the severity of the impact of this disease.”

Below are links to free helpful resources from HRS  (Training Videos, Webinars, and Bulletins)

https://hrstonline.com/covid-19-resources/

HCS Expanded Visitor And Emergency COVID-19 Mitigation Rules

HHSC Publishes HCS Expanded Visitor Attestation Rules & Guidance Letter

September 25th, 2020

HHSC Visitor Expansion Rule.  See the following rules in PDF updated on 9/25/20.  https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/hcs/hcs-covid-19-updated-emergency-rules.pdf

PL-20-40 is the letter providing guidance for the new rules  The new attestation form is at the bottom of this alert letter from HHSC.  See the following PDF of PL-20-40:  https://apps.hhs.texas.gov/providers/communications/2020/letters/PL2020-40.pdf


 

 

 

HCS Emergency COVID-19 Mitigation Rules 

Click on link below to see new rules that were adopted!

hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/hcs/hcs-covid-19-emergency-rules.pdf

LTC Expanded Facility Visitation Rules For Re-Openings in Texas

 

 

An ICF resident, as well as an individual living in an HCS group home, may have up to 2 Essential caregivers, as defined in the emergency rules, and they must have a negative COVID-19 test result from a test performed no more than 14 days before the first essential caregiver visit unless the facility chooses to perform a rapid test prior to entry into the facility.  Providers are still seeking clarification for some of the new COVID-19 emergency mitigation rules (including visitation rules) for persons receiving HH/CC services.  We plan to keep you updated!
Expanded ReopeningVisitation:
Phase 1 requirements all remain in place (except for compassionate care visits, which are being replaced with less restrictive essential caregiver visits.)
All facilities without an active facility acquired outbreak can move to visitation as outlined in the emergency rules(including those with isolation wings), but visitation is only allowed for residents/individuals,  who are NOT COVID positive and in areas away from COVID positive isolation areas.
Essential caregivers will be trained by the facility on PPE use and infection control, and they must meet the testing requirement.
Reopening is optional for facilities; those that do not feel they have the resources to re-open safely will not be mandated to open or allow for essential caregivers.
See the link below for more information on Visitation Rules for LTC Facilities, including ICF and HCS
https://hhs.texas.gov/sites/default/files/documents/services/health/coronavirus-covid-19/reopening-visitation-ltc-facilities.pdf 

HCS Billing Guidelines Revised-Sept. 2020

September 6, 2020

HCS Billing Guidelines Revised-Sept. 2020

Please pay special attention to the changes and clarifications for Nursing Services!  We will be reviewing these in our “Billable Services-HCS-2020” webinar on Sept. 21st, 2020.  For more information please contact Meghan Jones to register:  meghanjones.tx@gmail.com   If you attended the recent Billable Nursing Services training in August (Part I and II) we did add these to your handouts at the time of the training.  You have the updated ppt. copy.  Thanks.  Here is the link to the HCS BG’s: 

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/resources/hcs/hcs-billing-guidelines.pdf

TMHP-Launching Redesigned Website

Texas Medicaid Health Portal
TMHP is announcing the launching of their newly redesigned website available on September 14, 2020!
As TMHP.com receives approximately 2.5 million views per month, it important to have a website that is functional and easy to navigate.  Major improvements have been made to increase the website user experience for providers.
Highlights of new improved features include:
o   Simplified navigation with program information, topics, and resources are more easily accessible.
o   Ability to filter news articles and forms by program, topic, or category.
o   Mobile-friendly design construction allowing providers to view the site on a computer, tablet, or phone.
o   Easy entry points to online portals and manuals.
Please note:  Since the website has been completely redesigned, URLs have changed for all pages with the exception of the homepage of tmhp.com. If providers have links embedded in their websites or applications, they will need to update the links. If a “favorite” has been saved in their browser, providers will need to update their shortcut.
A video showing a preview tour of the NEW website is available on TMHP’s YouTube channel.
TMHP posted an article entitled Reminder: TMHP Website Redesign Beginning September 14, 2020 last week sharing the news.
Please send an email to provider.relations@tmhp for any questions related to the new website redesign.

We Have New Services!

Twogether Consulting has added some new services to include:

DEVELOPMENT OF INFECTION CONTROL POLICIES & PROCEDURES, or at least to update your one with COVID-19 policies and protocols.  

(Based on Guidance noted in the HCS & ICF COVID-19 Response Plans                                                      

HCS-covid-response-plan.pdf     ICF-covid-19-plan.pdf

DEVELOPMENT OF EMERGENCY EVACUATION PLANS  In particular, so HCS/TxHmL providers are able to meet  compliance with Appendix K:  Emergency Preparedness and Response and COVID-19 Addendum

Appendix K-Emergency Preparedness and Response-COVID-19

Both of these items will most likely be requested of the provider, at some point during the survey process in the near future. (That’s if you have not already been asked to provide these items.)  This is especially true if the surveyor sees that you are not in compliance with HHSC’s COVID-19 Response Plan Guidance for the providers and CDC guidelines that are referred to in both of these documents.  These of course will definitely tie into TAC code citations and ICF Tags, particularly nursing and possibly ANE TAC codes for both programs (neglect in particular). 

For both of these services, contact us at:  info@twogetherconsulting.com   We would be glad to invoice you or you can notify us to make arrangements and then make payment at https://twogetherconsulting.com/payments/ 

 

OFF-SITE SERVICES TIME BLOCKS:  We now offer packages of 3 hrs, 6 hrs, 9 hrs and 12 hrs for those of you who need quite a bit of periodic off-site assistance services including but not limited to:: Question & Answer Sessions, Resources, Individual Policies or Procedures, Creating Forms,  and Other Inquiries.  Previously we only had 3, 6, and 9 hr blocks.  12-hr blocks purchased at one time will be at $60/hr (Total= $720)  For more information go to:  https://twogetherconsulting.com/services/off-site-services/   You may request an invoice or make direct payment instead to:  https://twogetherconsulting.com/payments/

This does not include Complete/extensive Policies and Procedures, Employee Handbooks, CAPs/POC’s , DIT’s, Webinars, or Off-site TrainingPlease be sure to contact me directly if you have or are going to purchase online, and you would like to schedule some specific time for consultation javasbja@aol.com 

OFF-SITE RN CONSULTATION:   RN only consultation is available for $75 per hr.  
This is an option to pre-purchase hours with our RN Consultant who specializes in assistance to HCS/TxHmL and ICF providers.
For those of you who need periodic assistance off-site, including but not limited to:: General Inquiries about nursing services and concerns in these programs (via phone calls, video chat, email or text).  If you would like to schedule a teleconference or video conference with our RN Consultant and your nursing department or other members of your team, please contact us at info@twogetherconsulting.com  This is a great way to prepare for a survey, discuss post-survey concerns, develop ideas for plans of correction, discuss nursing concerns about an individual prior to admission, or assist nurses with new admissions to the program.  
 
This service does not include:  the actual development of policy & procedure or assistance with writing plans of CAP’s/POC’s, DIT’s, Webinars, or Off-site Training.  Please contact us at info@twogetherconsulting.com if you need these services.
 LON INCREASE PACKETS
(This is for off-site assistance only with LON increase packets)
 As a provider often times you may realize that some of your individuals do not have the correct LON (Level of Need)/  Now you may be aware that you have to request a new level of need, but do you know how to go about requesting that increase in the level of need?  Do you know what goes into the LON increase request packet?  Even if you know what to do, do you have time to fool with completing one?   Let us help!  We will have you send your documents to a private and secure shared folder, or you may choose to fax your documents  We will review the items and discuss them with you: what documents are missing, incomplete, or issues that may need to be addressed, as well as and concerns we have about the individual.  We provide recommendations and a list of all the appropriate documents including the order to put them in, to the provider.  We also write your cover letter for the increase and fill out your IDRC.  The provider will be responsible for then putting copies of those items in a packet and sending it off to the Utilization Review Department at HHSC for review.   You may choose hourly rate of $80/hr or flat rate of $800 for each LON increase packet we assist with off-site.  Please be sure to contact me directly prior to payment, even if you are going to purchase the flat rate directly online, so we can discuss your arrangements for off-site services including shared file options.  javasbja@aol.com 

SCORING ICAPS: Some providers are brand new or may have a small number of individuals in their program.  Sometimes you just can’t afford the initial cost of purchasing the ICAP scoring system or you simply don’t know how to use the scoring system very well.  So if you have ICAP renewals due or are requesting a LON increase, for example, we will be glad to score your ICAP’s for you.  Please give us at least 5 days’ notice, if possible.  The cost is $25 per ICAP online if you purchase at our “Store”. https://twogetherconsulting.com/store/

We can provide a discounted rate if you have more than 5 ICAP’s at one time that needs to be scored. Contact us at:  info@twogetherconsulting.com   We would be glad to invoice you,

Nursing Peer Review Process-If your facility needs training on the Nursing Peer Review Process or needs help with performing a Nursing Peer Review, please let us help.  You can contact us at info@twogetherconsulting.com to request assistance.  Remember, the provider can often use this process to assist the nurse and to prevent the nurse from going before the BON (Board of Nursing) if it is determined that the issues can and should be addressed by the facility and the nurse.  The nurse uses a group of his/her peers to assess the situation, determine the seriousness of the concern or allegation, and recommend appropriate corrections and solutions by the nurse and the facility.  This process can be used to correct certain nursing citations as well and again, possibly prevent the nurse from being reported to the BON. 

FYI-If you have 10 or more nurses working for your program (ICF, HCS, TXHmL, etc….), the BON requires the facility to have a “Nursing Peer Review Committee” to review Nursing Infractions and all facilities could benefit greatly from having some kind of “Nursing Peer Review Process” in place.

 [NPR §303.0015 ]

“Any person or entity that employs, hires, or contracts for the services of 10 or more nurses (RNs, LVNs or any combination thereof) must have a Peer Review Plan; however, peer review of RNs is not mandatory if the facility employs less than 5 RNs. A person or entity required to have nursing peer review may contract with another entity to conduct nursing peer review.”

 What is Peer Review? [Nursing Peer Review (NPR) §303.001(5)]

Peer review is the evaluation of nursing services, the qualifications of a nurse, the quality of patient care rendered by nurses, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint including:

  1. the evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse;
  2. a report made to a nursing peer review committee concerning an activity under the committee’s review authority;
  3. a report made by a nursing peer review committee to another committee or to the Board as permitted or required by law; and
  4. implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of the committee.

A Peer Review Committee may review the nursing practice of an LVN, RN, or APN (RN with advanced practice authorization).

There are two kinds of nursing peer review:

  1. Incident-based (IBPR), in which case peer review is initiated by a facility, association, school, agency, or any other setting that utilizes the services of nurses; or
  2. Safe Harbor (SHPR), which may be initiated by an LVN, RN or APN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer.

See revised rules 217.19 (Incident-Based Nursing Peer Review and Whistleblower Protections) and 217.20 (Safe Harbor Peer Review and Whistleblower Projections){http://www.bon.state.tx.us/nursinglaw/rr.html}

We are sorry to say, that our plan to start providing training again with Nursing CNE’s has been put on hold, due to the Pandemic (COVID-19).  We will keep you posted.

 

 Provider Specific Training now being offered by Twogether Consulting

  • Training (Off-site) to Providers concerning Direct Care staff’ssurvey interviewer interaction with Surveyors during interviews and how this can affect the provider, particularly the nursing department, as well as preparing for the survey in general.  (HCS, TXHmL, and ICF)
  • Training (Off-site) to Providers concerning “Nursing Expectations of Direct Care Staff and It’s Importance”  (HCS, TXHmL, and ICF)
  • Training (Off-site) to Providers concerning Nursing Staff’s interaction with the Surveyors, particularly during the interview process with the nurse.  (HCS, TXHmL, and ICF)
  • Training (Off-site) Other Direct Care staff training such as Abuse Neglect & Exploitation Reporting and Follow-Up for HCS/ICF, including PPT handouts,  Quiz and Inservice Sheet for your records or Certificates of Completion. This training does meet the new requirements listed in the current HCS TAC Code 9.175                                                         Let Twogether Consulting provide your facility with one on one webinar training.

HCBS Settings Regulation Implementation -Timeline Extension!

Frequently Asked Questions:
HCBS Settings Regulation Implementation and Heightened Scrutiny Reviews of Presumptively Institutional Settings:
July 2020 Update
1.Question:
What is the new deadline for states to assure that all settings are in compliance with the home and community-based services (HCBS) settings criteria?
Answer: States have been granted an additional year to demonstrate compliance and should ensure all settings are in full compliance with the HCBS settings criteria by March 17, 2023. This date to demonstrate compliance replaces the March 17, 2022 timeline included in CMS guidance issued May 9, 2017.1 Several states have requested an extension to demonstrate compliance with the HCBS settings criteria due to an inability to complete site-specific assessment and remediation activities due to the COVID-19 public health emergency (PHE). Social-distancing requirements in response to the PHE are resulting in the inability to complete activities outlined in approved statewide transition plans and/or activities required to obtain final approval of those plans.
During this extension, CMS urges states to continue to identify settings in need of remediation and work on the development, approval, and implementation of their Statewide Transition Plans, including close consultation with relevant stakeholders. In light of the risks associated with congregate settings during the COVID-19 PHE, states may wish to give particular priority to those provisions of the rule regarding making available non-disability specific settings among the range of options available to individuals with disabilities, including to individuals currently residing in disability-specific congregate settings (for whom transition supports may be necessary to make the option available).
In addition, CMS reminds states that they continue to have independent obligations to comply with the Americans with Disabilities Act, Section 1557 of the Affordable Care Act, and Section 504 of the Rehabilitation Act, including their requirements under Olmstead v. L.C.2, which remain in effect during this public health emergency. Technical assistance is available from the HHS Office for Civil Rights and the Department of Justice Civil Rights Division.
2.Question:

What assistance is available to states to address the impact of the COVID-19 PHE on statewide transition plan activities?

Answer: States can review up-to-date guidance on flexibilities available for the delivery of HCBS on the CMS website.
 States can also avail themselves of individual and small group technical assistance from CMS, including alternative ways to gather site-specific assessment data and conduct validation activities. CMS also is available to offer assistance with approaches to gather information from beneficiaries and other stakeholders when face-to-face contact is impacted by state or local restrictions due to the COVID-19 PHE.

On-Site Trainings Available Upon Request

Currently, all “On-site Training” is on hold due to COVID-19.  If you require any of these trainings, please check our calendars on our website for current webinars or contact us at:  info@twogetherconsulting.com for some of our pre-recorded training options.

Live Training On-Site (Please contact us if you want us to provide these trainings on-site for your program):

HCS/TxHmL: Care Coordination in the HCS Program, Using Person-Centered Thinking To Develop The IP (Implementation Plan), Changes in the HCS Progam, Quality Assurance, Changes in The Survey Process In HCS (we are adding one for ICF), Changes in The Billing Audit Process in HCS and TxHmL, Nursing in HCS/TxHmL Programs, Common Nursing Errors In The HCS/TxHmL Programs & Corrective Action Planning, ICAP/IDRC/ and LON Increase Packet Training.

ICF: The Role & Responsibilities of the QIDP, DIT on Active Treatment, Changes To the ICF Surveyor’s Guide-Appendix J- “How It Affects Your Program”, as well as DIT Trainings-A/N/E,  “Common Nursing Tags in the ICF Program-How to Prevent & Correct Them“, Nursing In The ICF Program as well as ICAP/IDRC/ and LON Increase Packet Training.

Direct Support Staff Training:  “Expectations of the Nurse from the Direct Support Staff”, “Abuse, Neglect, and ANE” (including recent changes in the HCS TAC), “When and What to Report To The RN”, Documentation Expectations for Direct Support Staff”, “Behavior Support Plans-general concepts and purpose of support plans”, “Interacting With Individuals with Developmental Disabilities in Your Program” (Effective Communication, Verbal Intervention, Appropriate/Inappropriate Reactions, Body Language, and more).

Employment Assistance & Supported Employment Training Options From HHSC

Employment Assistance & Supported Employment Training Options From HHSC

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

The web-based trainings cover employment services provided through HCS and TxHmL, information about the payer of first resort for employment assistance, and the basics of providing these services. They are designed to enhance staff knowledge about providing quality employment services to people enrolled in the waivers.

Each training has a corresponding quiz.

 

The Direct Service Workers web-based training provides information about employment services and how direct service workers can support people achieve their employment goals. The training covers federal and state initiatives related to employment for people with disabilities and touches on issues related to people who work and receive SSI or SSDI benefits. The training has a corresponding quiz.

Enhanced Provider Portal, Relief Fund Payments Available For Providers!

Tuesday, June 9, 2020

HHS Announces Enhanced Provider Portal, Relief Fund Payments for Safety Net Hospitals, Medicaid & CHIP Providers

Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is announcing additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program (CHIP) providers that participate in state Medicaid and CHIP programs. HHS expects to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution. HHS is also announcing the distribution of $10 billion in Provider Relief Funds to safety-net hospitals that serve our most vulnerable citizens. The safety net distribution will occur this week.

“Healthcare providers who focus on treating the most vulnerable Americans, including low-income and minority patients, are absolutely essential to our fight against COVID-19,” said HHS Secretary Alex Azar. “HHS is using funds from Congress, secured by President Trump, to provide new targeted help for America’s safety-net providers and clinicians who treat millions of Medicaid beneficiaries.”

HHS is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion in relief funds to hospitals and other healthcare providers, including those disproportionately impacted by this pandemic.

ENHANCED PROVIDER RELIEF FUND PORTAL

On Wednesday, HHS is launching an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

The initial General Distribution provided payments to approximately 62 percent of all providers participating in state Medicaid and CHIP programs. The Medicaid and CHIP Targeted distribution will make the Provider Relief Fund available to the remaining 38 percent. HHS has already provided relief funding to over one million providers, and today’s announcement is expected to reach several hundred thousand more providers, many of whom are safety net providers operating on thin margins.

Clinicians that participate in state Medicaid and CHIP programs and/or Medicaid and CHIP managed care organizations who have not yet received General Distribution funding may submit their annual patient revenue information to the enhanced Provider Relief Fund Portal to receive a distribution equal to at least 2 percent of reported gross revenues from patient care. This funding will supply relief to Medicaid and CHIP providers experiencing lost revenues or increased expenses due to COVID-19. Examples of providers serving Medicaid/CHIP beneficiaries possibly eligible for this funding include pediatricians, obstetrician-gynecologists, dentists, opioid treatment and behavioral health providers, assisted living facilities, and other home and community-based services, providers.

To be eligible for this funding, health care providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020. Close to one million health care providers may be eligible for this funding.

More information about eligibility and the application process is available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html

For updated information and data on the Provider Relief Fund, visit hhs.gov/providerrelief

News Releases below:                                                                                                                                                                                           

media@hhs.gov
www.hhs.gov/news
Twitter @SpoxHHS

Webinars

Please go to www.twogetherconsulting.com for more information and registration. Click on  “the calendar” of the Webinar you want to attend. 
********We also have pre-recorded webinars you can purchase for use at your facility.  Please contact Meghan Jones at: meghanjones.tx@gmail.com for more information, registration, and payment.

June & July

 

“Prep Session For HCS Provider Applicant Test” (Webinar)
(We will be reviewing some TxHmL information as well)

Date:  Tuesday- July 2nd, 2020

Time:  (6pm-8:30pm)  Central time

Cost:  $150/person

 

 

 

“Description & Development of The Comprehensive Nursing Assessment”  (HCS/TxHmL)

Date:  July 20th, 2020   

Time:  10AM-12:30 PM

Cost: $55/person

For:  Nursing Staff, Quality Assurance Staff, Program Managers, Administrators

Presenter:  Gina Peterson, RN Consultant

Please register for this webinar on or before June 20th, 2020  10:00 AM CDT

After you have made payment for this webinar,  you will receive a confirmation email containing the handouts and a link to register with “Gotowebinar” to attend that session.  

 

The Importance of SAM’s & Special Needs Training:                                     “RN Considerations for Training In IDD Programs”

(HCS/TxHmL/ICF)  July 30th, 2020  

 

Case Management/Care Coordination Webinar Series for HCS Providers 

(You can purchase pre-recorded sessions)

LIDDA Vs. HCS Provider: “Roles And Responsibilities-Timelines And Communication”

Webinar via Go To Webinar

Time:  2.5 hrs

Cost:  $50/person

You will receive a link to register for the webinar and the training handouts once we have received payment for the session.

For:  HCS Care Coordinator/Case Manager,  Program Manager, Administrator, Quality Assurance Staff, Nurses and more

Description:  This class is designed for anyone who is first starting out in the HCS Waiver Program as a new provider and for those persons coordinating services (case management) for the individuals in the HCS Waiver Program. This class is also effective for Nursing staff who need to know how the program works overall as they are part of the coordination of services for the individuals in the program.  Lastly, this is also a great session for those providing oversight and quality assurance for the program.

The discussion will include:

-What Does the LIDDA (Local IDD Authority) do?

-Who is the SC (Service Coordinator) at the LIDDA and what is their role and responsibilities?

-What are the HCS Provider’s role and responsibilities?

-When does the provider have to communicate with the SC?

-What are the timelines for certain responsibilities and expected communications on both sides?

-Who does “what” during enrollments, transfers, temporary suspensions, and permanent discharges?

-And much more

 

“Developing The IP (Implementation Plan) with Person-Centered Thinking in The HCS Program”

 

Time:  2.5 hrs

QA Session from 12:30 pm – 12:45 pm 

Cost: $50 per person

For:  Program Administrators, Program Directors, Care Coordinators, LIDDA Representatives- Service Coordinators, etc..

The webinar will be via “Go To ”Webinar

Instructions for the webinar and training handouts will be sent to your email after payment is made online or check is received.

Topics:

A review of basic components of a PDP (Person Directed Plan) completed by the LIDDA service coordinator and how this fits in with the IP (Implementation Plan) completed by the HCS provider.

Review of IP components and how to use the PDP to develop the complete IP. Review of some sample IP’S for various services on the IPC ( Individual Plan of Care).

Defining the terms: Action Plan, Desired Outcome, Objective, strategies, justifications.

 

 

LON/ICAP/IDRC Training for HCS, TxHmL, and ICF/IID Programs

 

 

Time:  2.5 hrs

QA Session from 12:30 pm – 12:45 pm 

Cost: $50 per person

For:  Program Administrators, Program Managers, Care Coordinators/Case Managers, Service Coordinators, Nurses etc..

The webinar will be via “Go To ”Webinar

Instructions for the webinar and training handouts will be sent to your email after payment is made online or check is received.

Topics:

-A review of the definition of LON (Level of Need) in the HCS, TxHmL, and ICF/IID programs

-What is the ICAP (Inventory for Client & Agency Planning) and how is it utilized?

-When does the provider complete an ICAP and Why Do They Need To?

-What is the IDRC (Intellectual Disability/Related Condition) form

-When is the IDRC filled out and by who?

-What does LON mean (Level of Need)?  (assistance needed, dollars required for that assistance level, etc…)

-How do I get a Level of Need increase?  Who applies for the Level of Need increase?  

-Utilization Review Department- what is their role?  (Monitoring units in CARE and Utilization of services, Approving Levels of Needs, etc…)

 

 

“Billable Services In The HCS Program″

You will receive a link to register for the webinar and handouts after we receive payment.

 

Time:2.5 hrs

Cost:  $65 per person

Presenter:  Julie Blacklock/IDD Waiver Consultant

For: Administrators, Program Managers, Quality Assurance Staff, Care Coordinators, Nurses, Billing/Data Entry Staff

Topics:  

-Definition of all Billable Services on the IPC (Individual Plan of Care)

Hourly and Daily Unit services such as RSS/SL, HH/CC, CFC (PAS-HAB), DH, REH, PT, OT, SP, DI, BES, CRT, AU, SW, CDS, etc…

-Other Services (Units in dollars only):  Adaptive Aids, Minor Home Modifications, Dental, Pre-Minor Home Mod and OT Assessment, TAS

– Recent and some Upcoming Changes in the HCS Billing Guidelines

-How does this affect the Provider?

-How can I use this change to improve services

-How do I document to capture the most billing?-How to prevent billing for non-billable services?

 

Texas Workforce Commission (Supported Employment)

Texas Workforce Commission

Update on TWC services Provider Manual and Resources 

The following revisions to the Vocational Rehabilitation Standards for Providers Manual (VR-SFP) are available for 30-day review on the Vocational Rehabilitation Providers’ Resources page and will go into effect on June 29, 2020.

Chapter 2: Obtaining a Contract for Goods and Services—updated Section 2.8.1 Adding Counties or Services, Goods, and/or Equipment to a Contract, to indicate that provider contracts awarded after January 2020 will be statewide and therefore will not list the counties to be served.

Chapter 17: Basic Employment Services—updated Section 17.4.1 Bundled Job Placement Services Service Description and its associated form VR1845B, Bundled Job Placement Services Plan—Part B and Status Report, to clarify which types of placements are acceptable for VR customers.

Chapter 18: Supported Employment Services—updated Section 18.1, Supported Employment Overview, and its associated form VR1643, Supported Employment Services Plan 2—Placement, Job Analysis &Training Plan, to clarify which types of placements are acceptable for VR customers.

Cost Reporting Update!

Cost Report/Accountability Report has been extended to June 15, 2020

A notice has been posted to the LTSS web-page and the vendor will be updating the STAIRS system by Monday.  HHSC has stated they do not anticipate any additional extensions will be made at this point; however, if this occurs they will keep everyone updated.

Notice:

The new due date for submission of the 2019 Cost Report and/or 2019 Accountability Report has been extended to June 15, 2020.

This new due date supersedes the original notification and any reminder emails that providers may have already received. 

This extension is for the following program types/services. 

  • Community Living Assistance and Support Services – Direct Service Agency (CLASS-DSA)
  • Deaf-Blind Multiple Disabilities Waiver (DBMD)
  • Early Childhood Intervention (ECI) – Case Management
  • Early Childhood Intervention (ECI) – Specialized Rehabilitative Services
  • Home and Community-based Services / Texas Home Living (HCS/TxHmL)
  • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID)
  • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions State Supported Living Centers/Bond Homes (SSLC/BH)
  • Nursing Facility (NF)
  • Primary Home Care (PHC)
  • Rehabilitation Services – Mental Health
  • Residential Care (RC)
  • School and Health and Related Services (SHARS)
  • Service Coordination – ICF/IID
  • STAR+PLUS services affiliated with the above service types
  • Targeted Case Management (TCM) – Mental Health

 The deadline for 24-Hour Residential Child Care (24RCC) and Day Activity and Health Services (DAHS) is still May 15, 2020, with one exception. If the 24RCC or DAHS provider is serving a COVID-19 confirmed positive client(s), the provider can be granted an extension to June 15, 2020. 

These providers will need to contact costinformation@hhsc.state.tx.us to request the extension to June 15, 2020.

Utilization Review Department News!

Last Friday HHSC posted the following CARE banner:  Due to the 09/01/2019 HCS rate increase, service authorizations are being updated to ensure they are in line with their corresponding IPCs. This will not cause any payment changes.
Upon inquiry as to what this meant, Holly Lindsey, UR, HHSC provided the explanation below.  Hopefully the explanation and guidance will be of assistance to you should an action (revision, renewal or transfer) be taken on an IPC which prompts a notice that the IPC exceeds the cost cap.
Message from Holly Lindsey:  Since the effective dates of the rate increases, providers have been paid at the appropriate rate for the corresponding service. However, the C62 and C72 screens do not update until a provider takes an action on the IPC that was effected. This can be a revision, a renewal, or a transfer. That is why providers are suddenly seeing “Exceeds” messages in CARE for the same services that were under the 100% capitation rate ($83,734) previously. The services cost more so the total cost is higher. This actually occurred months ago with the rate increase, however, it takes an action on the IPC for it to update.
Any IPC that is over the $83,734 level requires a packet to be submitted (TAC 9.160(d). However, since we are removing flags to allow for billing during COVID, it is not necessary to send a packet at this time. The next time an action is taken on the IPC, however, an “Exceeds” message will occur again, and CARE will prompt them to send a packet.
Removing the flag is currently a manual process, so providers can contact me (Holly Lindsey) directly through this email for flags related to cost.
Note from Twogether Consulting: If you have tried to enter a renewal on an IPC or IDRC into CARE and you are having problems, remember that IPC’s and IDRC’s are automatically renewed through April 30th, 2020.
For Assistance with either issue:
They can call the main UR # 512-438-5055 or
Holly Lindsey:  512-438-5704;  holly.lindsey@hhsc.state.tx.us

Person Centered Planning/ Practices Training Opportunities

Person-Centered Training Opportunities

 

HHSC Person Centered Planning/Practice Training Information

What Training Is Required?

Online Introductory Course

The Texas Health and Human Services Online Introductory Course is appropriate for any member of the planning team, including:

  • Legally authorized representatives
  • Family members
  • Friends
  • Nurses (required in some instances)
  • Behavior specialists (required in some instances)
  • Employment specialists (required in some instances)
  • Attendants (required in some instances)
  • Direct support professionals (required in some instances)
  • Anyone asked to be a member of the planning team

Note: To access and complete this free online training, please go to the HHS Learning Portal, create a user login, and follow instructions to complete the training.

 

Person-Centered Thinking Classroom Course

To register for the Person-Centered Thinking 2-day classroom course, please go to the HHS Learning Portal, create a user login, and follow instructions to register for a class that is most convenient to your location. Begin Training An introductory course also is offered by DirectCourseOnline. The online offering includes courses in Person-Centered Counseling (PCC) and Person-Centered Thinking and Practice. There are 12 lessons in all.

HHS Approved Full Training

The following training is approved by Texas Health and Human Services for people required to take the full training, specifically case managers, service managers and service coordinators. If you would like to submit a training course to HHS for approval, email: Medicaid_HCBS_Rule@hhsc.state.tx.us. Remember to keep your training certificate.

Live Classes

 

No other live training has been scheduled at this time, these sessions are suspended until we hear more about the Covid-19 virus to decide on whether or not these sessions would be advisable at this time.  We will continue with webinars and on-site training, until further notice. 

 

   

STATUS OF HCS RATES!

Status of HCS Rates as of Oct. 11th, 2019:

As of October 11th, 2019, members of the HHSC Rate Workgroup were notified that the proposed rule amendments to implement the HCS rates that will be effective Jan. 1, 2020 thru August 31, 2021 have been sent to the Texas Register and will be published next Friday. 
. Any claims with DOS 11/10/19, and after will pay at the new rates. Claims billed prior to 11/10/19 will be reprocessed over the next three months and conclude by January 31.  Provider letter should go out next week.
These are the increases that will be applied to the LON 1, 5 & 8 residential rates and the additional rate increases that will be applied to the LON 6 & 9 residential rates. 
 Note:  A public hearing on the rule amendments and rates will be held at HHSC in its Public Hearing Room on November 4, 2019.
 HHSC Rate Analysis Director, has indicated that the rate increases for RSS LON 6 and 9, Day Habilitation and Supported Home Living/CFC will be posted Monday, October 14, 2019 (at the latest, Tuesday, October 15, 2019).
Remember:  These rates will be implemented as proposed in July, 2019 and will be retroactively effective to September 1, 2019.

SUMMARY OF PROPOSED PAYMENT RATES
Effective September 1, 2019

PROPOSED RATES:   HHSC proposes to increase the payment rates for the HCS Supervised Living / Residential Support Services, Day Habilitation, Supported Home Living Transportation, Community First Choice (CFC) Supported Home Living, and CFC Consumer Directed Services Supported Home Living in accordance with the 2020-21 General Appropriations Act, 86th Legislature, Regular Session, 2019 (Article II, HHSC, Rider 44).
METHODOLOGY AND JUSTIFICATION
The proposed payment rates were calculated in accordance with 1 TAC Section 355.723, which addresses the reimbursement methodology for the HCS program.  See HCS rates packet proposal below for Sept 1st, 2019.  Click on link to HCS rates document. 

09-01-19-hcs-rate-packet

Please contact the Rate Analysis Department’s Customer Information Center at (512) 424-6637 or by email at RAD-LTSS@hhsc.state.tx.us should you have any questions regarding the information in this document.

BEHAVIORAL SUPPORT SERVICES PROVIDER POLICY TRAINING

Behavioral Support Services

HCS and TxHmL Behavioral Support Services Provider Policy Training

(Has been mandated for HCS & TxHmL providers to ensure their contracted Behavioral Support Services providers to take since March 2015)

This course informs service providers of behavioral support services in the HCS and TxHmL programs related to the provision of behavioral support services in those programs.  All new behavior support service providers must complete the WBT before providing services to an individual. All providers must complete the course every three years.

***To document successful course completion, participants must print a copy of the certificate provided at the end of the training and submit a copy to a program provider with whom they are employed or contracted.

HCS Survey Review Process, Billing Guideline Changes Summary & Provider User Guide for CARE

 

Survey Process:  Timelines

As everyone is aware, due to the COVID pandemic, the past several months have affected the Long-Term Care survey and enforcement processes and activities that are unrelated to the virus. As of June 15, 2020, Survey Operations has begun to resume some normal survey activity, and Enforcement is also resuming enforcement processes and activities, such as complaints or issues related to COVID-19.  No other regular survey activities have begun for HCS/TxHmL programs.
Please contact Enforcement Director Derek Jakovich by email at derek.jakovich@hhsc.state.tx.us if you have questions.
In response to questions regarding what normal survey and enforcement activities are resuming as of June 15 and what programs are affected, HHSC replied as follows:
To clarify, as of June 15, 2020, Survey Operations is resuming some survey activity such as complaints with lower priorities, and possibly some licensure and certification surveys. For Enforcement, due process notice letters such as denials, revocations, and imposition of administrative penalties will be issued and the opportunity to appeal will be provided. Of course, the COVID circumstances may affect these activities.
At this point, since we’re not enforcing administrative penalties in HCS/TxHmL until September, the notice applies to NF, ALF, DAHS, PPECC, HCSSA, and ICF/IID.

 Billing Guideline Changes

November 20, 2019

The HCS, TxHml, and CFC billing guidelines have been updated effective Nov. 15, 2019. A summary of the revisions can be found on page 25 of the CFC PDFpage 147 of the HCS PDF and page 129 of the TxHmL PDF. Send questions about the billing guidelines to HCS.TxHml.BPR@hhsc.state.tx.us.

HHSC Provider User Guide (CARE)       

Please go to the following link:

https://hhsportal.hhs.state.tx.us/helpGuide/Content/16_CARE/WaiverPDF/HCS%20Provider%20User%20Guide.pdf

.

Our Awesome Admin. Asst.

Our Awesome Admin. Asst.

Meghan Jones

Meghan Jones is our awesome Admin. Assistant, otherwise known as our “Jill of All Trades”.  She handles our registration, keeps up with our enormous provider contact list, our company schedule and calendar, and she is our main point of contact for scheduling, other than myself.  We couldn’t make it without our Meghan!  I know many of you have talked to Meghan over the phone.

You may contact her to complete registrations, set up on-site visits from our consultants, request invoice sent to you directly, or for other questions at: meghanjones.tx@gmail.com

HHSC IDD Operations Portal For Providers

April 15th, 2019

As of April 1, 2019, Long-term care intellectual and developmental disability providers and local IDD authorities can electronically submit and receive documents to and from HHS IDD Program Eligibility and Support and IDD Utilization Review.

Who Can Use the Portal?

If you contract with HHS to provide IDD services in the following programs, you can register and begin using the portal:

  • Community First Choice
  • Community Living Assistance and Support Services
  • Deaf-Blind with Multiple Disabilities
  • Home and Community-based Services
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities
  • Texas Home Living

What Are the Benefits?

To learn more, read the IDD Operations Portal Flyer (PDF).

Where Do I Register and Learn How to Use the Portal?

Complete the Initial Account Setup and register your business with the portal at txhhs.force.com. To learn more, read the IDD Operations Portal User Guide (PDF).

HHS will use email alerts, information letters, training webinars and in-person communications via existing stakeholder meetings to provide portal updates.

For technical issues, contact the IDD Operations Portal Team at IDD_Ops_Portal@hhsc.state.tx.us.

TASKMASTER PRO “Cloud-Based” Services For HCS, TXHmL, ICF, and CLASS Providers

logo

Discounted Rates Available for Small Providers (20 individuals or less) if you demo with Twogether Consulting to get signed up for TMP! 

As you know, we often provide webinars for providers receiving TaskMaster Pro services and this year some exciting new changes are taking place.  We are having a webinar on January 28th to review some of the new changes added to the nursing component of TaskMaster Pro, which include Comprehensive Nursing Assessment addition.  For those of you who are not receiving TaskMaster Pro currently, we also provide free demos.  Contact us at:  javasbja@gmail.com or meghanjones.tx@gmail.com to sign up for demo!

Developed by a provider for providers!

TaskMaster Pro is a web-based cloud computing system designed specifically for managing Waiver and ICF/DD programs. TaskMaster Pro was created by Larry Hill of Hill Resources in Abilene and his team. Through the internet, you will be able to access information and monitor activity from wherever you are and whenever you want and when regulatory changes occur or required forms are updated, TaskMaster Pro is updated so it will never be obsolete. Now this user-friendly, integrated system is available to you.

Request a TaskMaster Pro Demonstration

Manage your program anytime and from anywhere in the world with TaskMaster Pro!

This comprehensive, easy-to-use system has these features:

  •   Secure Communication Center
  •   Program Planning for QMRP’s, Case Managers, and Program Managers
  •   Complete Medical Module
  •   Psychological/Behavioral Module
  •   Service Delivery Log/Billing Waivers
  •   Client Budget
  •   Direct Care Reporting
  •   Incident/Accident Reporting
  •   Scheduling
  •   Report Tracking
  •   Human Resources
  •   Staff Development and Training Module
  •   Time and Attendance
  •   Electronic Data Signature
  •   Off-Site Secure Hosting
  •   Automated File Backup
  •  Customizable Access Control

Whether you have a large, mid-size, small or new start-up company, TaskMaster Pro will work for you!

For a FREE on-line demonstration of how TaskMaster Pro can save you time and money, please contact Julie Blacklock at  512-294-8032 or click on the Request a TaskMaster Pro Demonstration link to sign up.

Please note that before you can receive a demonstration, you must download and complete the Non-disclosure agreement and either fax the form to 512-291-9075 or scan it in and email it back to us available on our website: www.twogetherconsulting.com on the “TaskMaster Pro” page.

Additional Training Opportunities

 

HHSC JOINT PROVIDER LIVE TRAINING

Save The Date:  2020 Waiver, Survey & Certification Training

The training will cover a host of topics related to the HCS and TxHmL programs including, but not limited to, Administrative Penalties, Nursing Services, Amelioration and Informal Dispute Resolutions.  Registration information will be available online at HHSC in Spring 2020.        

2020 HHS Long Term Care Regulatory

Waiver Survey and Certification Joint Provider Training

SAVE THE DATE

June 30, 2020 to July 2, 2020  (3 days of training)

Location:

Crowne Plaza

6121 N IH 35

Austin, TX 78752

This collaborative conference will focus on a variety of topics central to the Home and Community-Based Services (HCS) and Texas Home Living (TxHmL) waiver programs.

Featured topics will include, but are not limited to: Administrative Penalties, Amelioration, Informal Dispute Resolution, Nursing Services, Aging, Residential Surveys, Critical Incidents, and more!

Program provider staff, leadership, nurses, and HHS surveyors are encouraged to attend.  Registration will be available Spring 2020.

Questions? Please contact Tahoe Fintel at (512) 438-3161

MEDICAID WAIVER PROGRAM WEB-BASED TRAINING FROM HHSC

Abuse Neglect and Exploitation Competency Training and Exam     

( WE RECOMMEND HCS/TXHML PROVIDERS HAVE DIRECT SUPPORT STAFF COMPLETE THIS TRAINING)

This training is designed to meet the basic ANE training requirements for staff providing direct care in a community setting. By the end of the training, staff should be able to identify which acts constitute ANE, how to recognize ANE, understand risk factors for ANE, and what methods can be used to address ANE. Additionally, this training includes an introduction to trauma and its impact on the people we serve.

Service providers must complete a test with a score of 80 percent or higher. A training certificate can be printed at the end of this training and kept in staff personnel files to meet training requirements.

To access and complete this free online training, please go to the HHS Learning Portal’s ANE Competency Training course page, create a user login, and follow instructions.

Texas Oasis Dementia Training Academy

P.O.W.E.R. ANE Training Academy

NF Culture Change – Transforming Care within the Regulations

Emergency Preparedness (FYI-Directed towards Nurses in Facilities)

For more information please see the following link:

https://apps.hhs.texas.gov/PROVIDERS/Training/jointtraining.cfm to register and learn more about each of these events.

Scope and Severity Webinar Now Available

HHSC is currently offering a webinar to explain scope and severity for providers impacted by House Bill 2025, 85th Texas Legislature, Regular Session, 2017. The training is designed specifically for providers for whom scope and severity is new to the survey process.

Register for the Scope and Severity Training for ALF, DAHS, ICF/IID and PPECC Providers webinar to see available dates and times here.

Please continue to monitor the website for additional dates and times if you are unable to participate during the dates currently being offered. The webinar will be offered on a regular basis for the next few months.

There are 2 more on Nov. 6th have opened up..  Register at:   https://apps.hhs.texas.gov/providers/training/jointtraining.cfm

Changes to the MWH-IDD Website where TIC Training is Accessed

HHSC Long-term Care Regulatory has issued Provider Letter (PL) 19-08: Trauma-informed Care (TIC) Training to replace PL 16-15. The PL informs providers of changes to the Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities website where TIC training is accessed.

This PL is addressed to Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions providers. Read the details of this PL here.