Twogether Updates

Letter From Twogether Consulting To Providers-Update


Hello Friends,

We have just made some changes to the website and we hope you like them.  Feel free to give us your feedback.  Specifically, the “Updates” page 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 October 30th, 2020 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: 
    • Webinar Registration:  Click on calendars on our website at or
    • Recordings of Free Webinar Series:
    • “Updates Page”
    • 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). .
  • 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:
    • 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:
  • 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:
    • 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:

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:

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

Thank you and be well,

Julie Andrews Blacklock/Owner & IDD Waiver Consultant


LTC 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 

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:   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:

HCS Emergency COVID-19 Mitigation Rules Adopted

HCS Emergency COVID-19 Mitigation Rules Adopted

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


HHSC Publishes HCS Level 1 Residence Attestation

HHSC LTCR has published the HCS Level 1 Residence Attestation for HCS providers. The document can be found on the HCS provider portal website under the COVID-19 Resources accordion.

TMHP-Launching Redesigned Website

Texas Medicaid Health Portal
TMHP is announcing the launching of their newly redesigned website available on September 14, 2020!
As 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 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:   We would be glad to invoice you or you can notify us to make arrangements and then make payment at 


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:   You may request an invoice or make direct payment instead to:

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 

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  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 if you need these services.
(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. 

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”.

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:   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 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){}

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.

EVV (Electronic Visit Verification) Updates




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 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:



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:


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!

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).



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


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!

September 7th, 2020

HHS 3 Line Logo
Blue Gradient

HCS and TxHmL Billing and Payment Quarterly Webinar

HCS and TxHmL Program Providers and other interested stakeholders can now register for the Billing and Payment Quarterly Webinar scheduled on September 30 from 3:30pm – 5:00pm (Central Standard Time).

Topics will include revisions to the HCS, TxHmL and CFC Billing Guidelines Effective September 1, 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 select “Curso para la prevención del abuso, negligencia y explotación (ANE)” to access the ANE training and test in Spanish.

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 512-206-3999 according 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. 

June 26, 2020


WS&C will resume survey activities as of July 1st, 2020 for HCS/TxHmL.


Administrative Penalties Update!

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

August 10th, 2020

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.

Save The Date:

2020 HHS Long Term Care Regulatory Waiver Survey and Certification Joint Provider Training  (Date has been moved!)

September 30 – Oct.2, 2020

Crowne Plaza
6121 N IH 35
Austin, TX 78752

This free collaborative conference will focus on a variety of topics central to the Home and Community-based Services and Texas Home Living waiver programs. Featured topics will include Administrative Penalties, Amelioration, Informal Dispute Resolution, Nursing Services, Aging, Residential Surveys, Critical Incidents and more.

( I am assuming these topics may change including adding COVID-19)

Program provider staff, leadership, nurses and HHS surveyors are encouraged to attend.

Registration will be available Summer 2020.

Questions? Contact Kristin Priddy at 512-438-3297.


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

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 or and to
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.$ext.ViewTAC?tac_view=4&ti=40&pt=1&ch=9

. Both HCS and TxHmL rules can be accessed here.

Email 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.

A 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.

ICF/IID & HCS/TxHmL Surveys Resuming!!!


LTCR will be resuming survey activity for ICF/IID, HCS, and TxHmL in August as follows:



Effective August 4, scheduling of all survey activity will resume, including recertification surveys for both health and life safety code.  All survey activity includes licensure surveys, follow-ups, complaint and incident investigations, and CHOW visits. Providers that are past or close to the end of their certification period will be scheduled first.

If you have questions about ICF/IID surveys, please contact your regional PM/RD or Renee Blanch-Haley  —



Beginning August 24th, 2020, HHSC will resume annual recertification surveys for HCS and TxHmL providers. Residential surveys will also resume for HCS providers.

If you have questions about HCS/TxHmL surveys, please contact Alyssa Naugle  —


ADP Services

Sad News!

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.

We also have a new liaison, Katie Marx, who will be presenting at our next webinar in our “free webinar series”, August 27th, 2020.  We hope you will join us and also get to know Katie!

Katie’s contact info:  913-9480112 and her email is,

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!!




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


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)  
Katie 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. 
Laura can discuss some other ways ADP can help you as well: other HR issues, staying in compliance and developing a safety manual.
Please see the presentation from Laura Throneberry on these topics at our Gotostage channel

Mention how you found out about ADP through “Twogether Consulting/ Julie Blacklock” to receive discounted rate for limited time on your first month of service.

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 Katie Marx or Mitchell Deter at ADP about these services and more.  Katie is our main contact and works with HCS/TxHmL provider client base in the Austin and Houston area for the most part, and their specific needs.  She does 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

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

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

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

Duration: 35 minutes

Available On Demand

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



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.






Free Webinar Series

Our free webinar session recordings previously recorded are currently posted on our “Gotostage” page.
 We are pleased to announce our guest for next in line for our “free webinar series”, Brittany Brown.  More details coming soon!!

Free Webinar!!

Guest presenters:

Brittany Brown/Insurance Broker


Date: Sept. 2020 (exact date to be added later)

Time:  Noon-1pm

Cost:  Free!!!

Where:  Webinar




COVID-19 Information


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.

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) – –  or
Renee Blanch-Haley (ICF/IID) –
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.


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 ( 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

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

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


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


  • 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


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)

  • Public Health Region

  • Local Public Health Organizations

  • Texas Division of Emergency Management:

  • Regional Advisory Councils

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

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.

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:

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.

Training Resources

College of Direct Support

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:

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

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.

Part II of this DSP Video Training session is as follows:  “The Role Of The DSP and The Corona Virus” Part II

Free Training For Those Who Support Persons With IDD s/communications-events/news/2017/01/free-training-people-who-support-clients-idd

HCBS Settings Regulation Implementation -Timeline Extension!

Frequently Asked Questions:
HCBS Settings Regulation Implementation and Heightened Scrutiny Reviews of Presumptively Institutional Settings:
July 2020 Update
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.

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: 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.


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

For updated information and data on the Provider Relief Fund, visit

News Releases below:                                                                                                                                                                                   
Twitter @SpoxHHS

ICF/IID Updates


FAQ’s (June 2020)

(Section) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)
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.

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.
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.
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.
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)
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 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:

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.
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.
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.
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.

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.
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.
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.
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.
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.
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 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, 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

March 13th ICF FAQ’s  See link below:

Survey Operations Resume as of June 15th, 2020

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 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.


Very Important Information:  ICF License Renewals!!!

Regardless of whether HHSC sends advance notice that a license is expiring, providers are responsible for applying to renew their licenses in a timely manner. Furthermore, operating an ALF, DAHS facility, HCSSA, ICF/IID, NF, or PPECC without a license is a violation of state law.2.0Policy Details & Provider ResponsibilitiesSubject to certain narrow exceptions, state law requires a person to have a license if the person:•establishes or operates an ALF;1•operates a DAHS facility;2•engages in the business of providing home health, hospice, habilitation, or personal assistance services, or represents to the public 1Texas Health and Safety Code §247.021.2Human Resources Code, §103.0041.

PL 20-03 January 9, 2020
If a person is a provider of home health, hospice, habilitation, or personal assistance services for pay establishes, conducts, or maintains an ICF/IID or an NF owner or operates a PPECC, the expiration date of a license is printed on the license.
A provider must apply for a renewal license before its current license expires if the provider intends to engage in the activity that requires a license after the current license expires.
If a provider submits a sufficient application to renew its license, including applicable fees, to HHSC before its license expires, the license continues in effect and the provider may continue to operate while HHSC is processing the renewal application. If a provider does not submit a sufficient application to renew its license before it expires and continues to engage in the activity that requires a license after the license expires, the person is violating state law. HHSC may take enforcement action or pursue civil remedies against a person under those circumstances as per the statute and regulations applicable to that provider type. If a license expires without being renewed, the person who held the license must apply for an initial license as a new applicant. The person may not engage in the activity for which a license is required until HHSC issues a new initial license. The applicant must meet all requirements for an initial license, including any Life Safety Code or construction requirements. Any waivers, such as waivers of requirements related to room size in a facility, that were granted under the expired license will no longer be in effect.

Texas Health and Safety Code §142.002.4Texas Health and Safety Code §252.031.5Texas Health and Safety Code §242.031.6Texas Health and Safety Code §248A.051. 726 Texas Administrative Code (TAC) §553.15(a)(2) and (e) for ALF, 40 TAC §98.15(a)(2) and (e) for DAHS, 26 TAC §558.17(a) and (g)(2)and (3)for HCSSA, 26 TAC §551.15(d) for ICF/IID, 40 TAC §19.208(e) for NF, and 26 TAC §550.106(a) and (e) for PPECC.

PL 20-03 January 9, 2020
The Texas Unified Licensure Information Portal, which is the system HHSC uses for issuing and renewing licenses, has not been notifying providers that their licenses are about to expire. This PL is to remind providers that the expiration date of a license is printed on the license and, regardless of whether HHSC sends advance notice of an upcoming expiration, a provider must take necessary action to renew a license so the provider is operating in compliance with state law.
Contact Information
If you have any questions about this letter, please contact the Policy, Rules and Training Section by email at or call (512) 438-3161.

Provider Joint Training Opportunities

Check out Joint Provider Trainings link from HHSC, for more info:



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.

Look for our live training session coming in July 2020 on Appendix Q changes!

“Changes to Appendix Q-Immediate Jeopardy for ICF and What That Means For The Provider”

Webinar in July, 2020

Appendix Q of SOMA (Immediate Jeopardy) Changes

CMS clarifications letter

Online basic training for Core Appendix Q is available on the Integrated Surveyor Training
Website at the following link:
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:  
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


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


























































Please go to 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: 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.


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.


-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


-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?


HHSC Provider Applicant Training (HCS/TxHmL)

Update:  HCS/TxHmL Provider Applicant Training/Testing

Currently, we do not have a definitive date for when HHSC will offer live Provider Applicant Training and Testing again.  There has been some mention of a possible live training and testing session August, but most likely this is doubtful to occur, due to COVID-19 precautions and rules of social distancing, really limit the options of a live testing session. 

We have had quite a few of our HCS/TxHmL provider applicants since the end of May, recently receive letters referring to them to take online orientation in the form of online training modules. (Online Provider Applicant Training through the HHSC learning portal which is a series of 13 modules).

The directions to these same provider applicants after taking the online orientation seems to indicate that the testing part of the application process is a bit of a “holding pattern”.  They have been told that they will be notified of further instruction on testing after completion of the “online provider applicant training modules” as soon as testing is scheduled.

**It has been suggested by a few of the applicant specialists at HHSC we have heard back from, that they will be notified to schedule a time to test with a proctor, so the testing may be one on one or with a small group.  We do not know if that will still be in Austin or various locations.

I will keep you posted on any new changes.   


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.


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 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;

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. 



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 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)

Regency Health Care  (Posted 3/9/20)                                                                                                                                                                                                                             (Round Rock, Tx)
Position opening:  Case Manager
Contact Robert Morris  : 
555 Round Rock W. Dr.   Bld. E, Ste 203.
Round Rock, Tx 78681
KENMAR Residential HCS
(Round Rock, Tx)
575 Round Rock West Suite F-360
Round Rock, Tx 78681
Currently have opening for Program Director  Posted 2/1/20
Contact:  Janet Simoneau
Office: 512-334-9192
Cell: 713-204-8071
The Center For Pursuit
(Houston, Tx)
Office location:  810 Marston St. Houston, TX 77019
Position is in Brookshire, Tx
Currently have opening for a QIDP  Posted 2/13/20
Location:  Willow River Farms- ICF
(Qualified Intellectual Disabilities Professional)
Contact:   Kevin R. Kern, MPA, C.A.L.A.  ( Chief Operating Officer)
Cell: 281-830-2686





  Brittany Brown/Medicaid Waiver Program-Payroll Specialist

How can BenefitMall help?

Assistance to HCS/TxHmL/and DH providers with their HR needs as well as payroll. Benefits Mall has some exciting new products for a very low cost that can possibly make a huge difference in ensuring quality assurance with your HR services and needs! Not all payroll companies are created equal. Brittany Brown is our contact at BenefitMall, and she is THE expert in working with Medicaid Waiver Programs.

Information on specific areas with your program that BenefitMall can assist you with.  Please give Brittany a call for more information and assistance:

  • Payroll cash flow issues
  • What does the IRS Tax Code really say about paying host home/foster parents and how can we alleviate some of the anxiety parents experience around their payments
  • Tracking employee time – dealing with employees working multiple division at different rates
  • Labor allocation to help ease the pain with cost reporting
  • Work Opportunity Tax Credits (WOTC)
  • So much more!

Contact Information for Brittany Brown

Mention “Twogether Consulting” when you contact Brittany Brown right now, for a free month of service and a full year of free W-2’s.  

Cell:  832-425-6410          Email:



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: Remember to keep your training certificate.


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.

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).
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. 


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


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.

Status of ICF/IID Rates!

Approved ICF Rates:  09/12/19

Click on the link below to read HHSC’s notice to ICF/IID providers about the ICF/IID rates.  The notice informs providers that the rates have been approved but at a lower rate than proposed.  The notice further explains that errors in the calculation of the rates resulted in the variance between the rates proposed versus the rates finally approved. 
The rates will be retroactive to September 1, 2019.  Providers will receive a supplemental payment to cover the difference between services already billed/payments already received based on the FY 2019 rates and the newly adopted FY 2020 rates.


Enforcement of ICF/IID Administrative Penalties Begins Sept. 1

HHSC Long-term Care Regulatory has issued Provider Letter 19-20 Enforcement of State Licensure Violations. The provider letter informs ICF/IID license holders that, effective Sept. 1, 2019, HHSC will begin assessing administrative penalties for licensure violations based on the scope and severity of the violation. Read the details here.

 ICF/IID providers, please remember to contact us for assistance with Survey Prep, Plans of Corrections and especially Directive Inservice Trainings, so we can assist in helping providers avoid administrative penalties, whenever possible!

**Note- I have already put in an email asking about other dates for the scope and severity training webinars as the ones on Sept. 5th are full.

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 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

HHSC Provider User Guide (CARE)       

Please go to the following link:


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:

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


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: or 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: on the “TaskMaster Pro” page.

Additional Training Opportunities



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


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


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


Abuse Neglect and Exploitation Competency Training and Exam     


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: 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:

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.