Twogether Updates
Long-Term Care Provider Webinar Recording on the End of Continuous Medicaid Coverage (ALF’s, NF’s, ICF’s & HCS)
May 15th, 2023
Recording Available of Webinar For LTC Provider Webinar on the End of Continuous Medicaid Coverage!
HHSC hosted additional live webinars in March and April of 2023, to inform providers about the end of continuous Medicaid coverage.
The webinar provided information about how long-term care providers (including nursing facilities, assisted living facilities, home and community support services agencies, Medicaid waiver providers, and intermediate care facilities for individuals with intellectual and developmental disabilities) can assist their Medicaid clients as continuous Medicaid coverage ends.
This is from the March 29 webinar. A recording is available here.
Email questions to: update@hhs.texas.gov
Guidance for HCS, HCSSA, ICF, and TxHmL Providers Related to Cooperation with HHSC Provider Investigations (PL 2023-11)
May 14th, 2023
Guidance Related to Cooperation with HHSC Provider Investigations (PL 2023-11)
HHSC has published PL 2023-11 Cooperation with HHSC Provider Investigations (PDF). The letter reminds providers that they must cooperate with Health and Human Services Commission Provider Investigators who are conducting investigations of abuse, neglect, and exploitation.
Clarification on HCS and TxHmL IPCs status in “Pending DADS Review”
May 14th, 2023
Reminder
Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs) and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) have been submitting forms and claims to the Texas Medicaid & Healthcare Partnership (TMHP). In response to questions and concerns related to the processing of Individual Plan of Care (IPC) forms, HHSC is clarifying required actions by submitters and how they parallel to processes in Intellectual Disability (ID) Client Assignment and Registration System (CARE).
Renewal and Revision IPCs
Renewal and Revision IPCs in either “Pending DADS Review” or “Pending Coach Review” require action from the submitter. This is typically the submission of supporting documentation. The IPC will not be reviewed until action is taken. This is the same process in place for “Exceeds” flags in ID-CARE.
A packet submitted to UR must include:
- IPC Cover Sheet (form 8599, which can be found at https://www.hhs.texas.gov/regulations/forms/8000-8999/form-8599-individual-plan-care-ipc-cover-sheet)
- Copy of signed IPC, all pages
- Person-Directed Plan
- Implementation Plans for all services on the IPC, including breakdown of nursing and behavior hours, if requesting
A packet may include, depending on the services requested:
- Comprehensive Nursing Assessment (Form 8584 or a form with all of the same elements) for nursing hours
- Occupational Therapy (OT) evaluation, treatment plan or assessment (include orders) for OT hours
- Physical Therapy (PT) evaluation, treatment plan or assessment (include orders) for PT hours
- Speech/Language Therapy evaluation, plan or assessment (include orders) for Speech hours
- Dietary evaluation for Dietary hours (include orders)
- Dental treatment plan, if applicable
- Behavior Support Plan for Behavioral Support hours that meets HHSC criteria
- PAS/HAB Assessment (form 8510) for PAS/HAB hours
- Transportation Plan (form 3598) for Transportation hours
- Audiology Treatment plan (and orders), if applicable
- Cognitive Rehabilitation Therapy plan, if applicable (in HCS)
- Support Consultation plan, if applicable (in HCS)
- Social Work plan, if applicable (in HCS)
- All documentation for Adaptive Aids, if requesting, including the following:
- A list of items to be purchased, the number of each item needed, and the cost (based on the lowest bid) for each item
- Three bids for each item. Bids from online vendors are acceptable. If using an annual vendor, three bids are needed only if an item costs $500 per month or more; otherwise, annual vendor bid can be submitted.
- Proof of Medicaid denial and professional recommendations, as required in Appendix VII of the HCS Program Billing Requirements
- Please see Section 6100 of the HCS Billing Requirements at https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/long-term-care/hcs-billing-requirements.pdf for more information.
- All documentation for Minor Home Modifications (3 bids based on the specs, specs from licensed professional recommendation), if requesting (please see Section 6200 of the HCS Billing Requirements).
Enrollment and Transfer IPCs
Enrollment and transfer IPCs remain in “Pending DADS Review” while the enrollment or transfer is being processed.
Enrollment IPCs may require additional documentation to be submitted to Program Eligibility and Support (PES). If an enrollment requires additional documentation, PES will contact the LIDDA who submitted the enrollment IPC.
Transfer IPCs always require a “transfer packet” to be submitted to PES. If a transfer packet requires additional documentation, PES will contact the LIDDA who submitted the transfer IPC.
A “transfer packet” submitted to PES must include:
- Request for Transfer of Waiver Program Services (form 3617)
- HCS Only: Individual Plan of Care (IPC) – HCS/CFC (form 3608)
- TxHmL Only: Individual Plan of Care – TxHmL/CFC (form 8582)
If an enrollment or transfer requires utilization review, Utilization Review (UR) will contact the LIDDA who submitted the enrollment or transfer packet.
Packet/Documentation Submission Details
The most efficient mode of submission for HCS/TxHmL documentation is through the IDD Operations Portal. To learn how to register and use the IDD Operations Portal or for answers to any questions, please visit https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/idd-ops-portal or email IDD_Ops_Portal@hhsc.state.tx.us. Packets may also be submitted via fax at 512-438-4249.
Questions
For questions about review packets, submitters can contact HHSC UR department at 512-438-5055 or email deskURLONIPC@hhs.texas.gov.
For questions about enrollments or transfers, submitters can contact PES at 512-438-2484 or email enrollmenttransferdischargeinfo@hhs.texas.gov.
Upcoming Provider Webinar
HHSC will discuss this topic during the December 8th, 2022, TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar.
Please click on this link to register for this webinar.
If you are unable to attend the webinar, please click on this link to access the December 8th, 2022, TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar recording. Please note: this recording should be available by December 15th, 2022.
Avoid Recoupment From TMHP (HCS/TxHmL)
May 14th, 2023
On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System (CARE) and TMHP and will recoup services that exceed the authorized IPC amount. (From May 1st, 2023 forward)
Pay Increase For Community Attendants & Direct Care/Support Workers:
May 13th, 2023
Community Attendants & Direct Care/Support Workers:
Direct care/support workers & community attendants are a huge part of the Medicaid long-term services and supports system. Without these persons working with our individuals, HCS, TxHmL, CLASS, ICF and other programs would not be able to provide services. The long-term services and supports system in Texas would simply not exist without a workforce of direct care/support workers. The Texas House and Senate have passed their budgets and are now in a conference committee to finalize the ‘Texas’ budget for the state fiscal year 2024 through 2025. (Prior to this meeting the Senate ad House have not been in agreement on how much the increase of funding will be)
The Senate version of the state budget raises attendant wages by almost 40 percent. And while it is still not the $17 per hour we were initially asking for, it would still be a large increase from what providers have at this time and it would really help with staff retention and attracting more DCS/DSW workers to these programs. Numerous Texans with disabilities rely on direct care/support workers every day. Without these workers, many of them could not remain in their community and might end up placed in more restrictive settings like institutions such as an SSLC (State Supported Living Center).
Please take time to call:
- Senator Lois Kolkhorst (Article II): 512-463-0118, 512-463-0360
- Representative Jacey Jetton (Article II): 512-463-0710
Important- Recordings Available From HCS and ICF Webinar COVID-19 from HHSC
May 2023 MCS COVID-19 Stakeholder Information Session
Thank you for your interest in listening to the May 2023 Texas Medicaid CHIP COVID-19 Information Session.
The audio from this session can be found here.
The presentation can be found here.
This is the last scheduled stakeholder recording for COVID-19 updates.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
January 12 Texas Medicaid CHIP COVID-19 Information Session.
These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.
The audio from this session can be found here.
The presentation can be found here.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
December 1 Texas Medicaid CHIP COVID-19 Information Session.
These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.
The audio from this session can be found here.
The presentation can be found here.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
Medicaid and CHIP Services Has Updated Its Process of Sending Monthly COVID-19 Updates
In the past, these updates were sent via an email from Outlook. Beginning with the December update, the MCS COVID-19 Stakeholder Update will be sent via GovDelivery.
If you wish to be removed from the MCS COVID-19 Stakeholder Update distribution list and not receive anymore alerts, please reply with “OPT OUT”.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
September 1 Texas Medicaid CHIP COVID-19 Information Session
These sessions will continue to share information with stakeholders about the implementation of various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic.
The audio from this session can be found here.
The presentation can be found here.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
For additional questions, please write to Medicaid_COVID_Questions@hhsc.state.tx.us.
COVID-19 ICF/IID Webinar Recording from April 11 Available
The April 11 recording of the Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Q&A with HHSC Long-term Care Regulation and DSHS is available.
The PowerPoint is updated with information given in the DSHS webinar.
Listen to the webinar recording here.
Email LTCR Policy for the transcrip
COVID-19 ICF/IID Webinar Recording from Feb. 14 Available
A recording of the Feb. 14 Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions COVID-19 Q&A with HHSC Long-term Care Regulation and DSHS is available for those who could not attend.
There have been changes made to the PowerPoint based on the information provided by DSHS during the webinar.
Listen to the webinar recording.
Email LTCR Policy for the transcript.
HCS, TxHmL COVID-19 Response Webinar Recording: Jan. 27 and Jan. 30
This webinar reviewed information from the revised COVID-19 Response Plan for HCS and TxHmL.
This includes strategies to rapidly identify COVID-19 and:
- Prevent its spread
- Protect individuals, staff, and visitors
- Provide care to infected people
- Recover from an outbreak
They also addressed the surge of COVID-19 across the state, address staffing shortages and provide you guidance from the CDC.
. A recording of this webinar is now available as of Jan. 31 at GoToStage.
HCS and ICF/IID providers who attended the webinar from HHSC on 1/19/22.
- Recently HHSC re-issued and, in some cases, issued updated policies and guidance for all IDD COVID-related documents.(1/5/22 and 1/7/22 for HCS concerning guidance booklet updates).
- HHSC is working to reorganize the COVID-related information, including COVID flexibilities and Appendix K waivers, on the ICF/IID and HCS home webpages to facilitate ease in access.
- HHSC did communicate the above and other changes and policy clarifications with providers via a webinar on January 19th, 2022, however many questions were still unanswered and attendees were told that questions that were not answered should be addressed in an FAQ from HHSC within 2 weeks of the webinar.
Jan. 19 Recording of HCS and ICF/IID COVID-19 Webinar Available
A recording of the Jan. 19 for Home and Community-based Services and Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions webinar with LTCR is now available.
Listen to the webinar recording here.
Read the webinar slide presentation (PDF).
Email LTCR Policy for the transcript.
Termination of Waiver Services Due to Denial of Medicaid Eligibility
May 12th, 2023
Important Reminder: Denial of Medicaid Eligibility
HHSC has published IL2023-16 Termination of Waiver Services Due to Denial of Medicaid Eligibility.
On Dec. 29, 2022, Congress passed the 2023 Consolidated Appropriations Act, which separated continuous Medicaid coverage requirement from the Public Health Emergency declaration. The requirement for states to maintain continuous Medicaid coverage ended as of March 31, 2023. States may begin disenrolling members effective Apr. 1, 2023.
HHSC must conduct a full redetermination and allow members 30 days to respond to renewal packets or requests for information. If an individual enrolled in a waiver program is no longer eligible for Medicaid, the individual’s waiver program services will also end. This IL also includes information on how to help individuals prevent the loss of waiver services and how to monitor loss of Medicaid eligibility.
If you have questions about the termination of Medicaid eligibility, please call 2-1-1 or email update@hhs.texas.gov.
If you have questions about the termination of an individual’s CLASS, HCS, or TxHmL services, please call the IDD Program Eligibility and Support message line at (512) 438-2484.
If you have questions about the termination of an individual’s DBMD program services, please call the IDD Utilization Review message line at (512) 438-4896.
Infection Control Resources (2023 Update)
May 2nd, 2023
Infection Control Resources from HHSC
- Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF)
- Infection Control Basics & PPE Training for Essential Caregivers (PDF)
- Helping Individuals with Intellectual Disabilities and Related Conditions Prevent the Spread of COVID-19 (PDF)
- Long-term Care COVID-19 Vaccination Options (PDF)
Resources Created by HHSC
- Evidence-Based Best Practices: Infection Control is a guide for developing a facility-wide system for infection prevention and control.
- Quality Monitoring Program Immunizations web page includes information for developing a system for immunizations, as well as the current CDC guidelines for common vaccine-preventable diseases.
Center for Disease Control and Prevention (CDC)
- Infection Prevention and Control Assessment Tool for Long-term Care Facilities (ICAR) can be used by nursing facilities to evaluate their Infection Prevention and Control programs and practices.
- Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19 Pandemic) provides strategies for preventing the spread of COVID-19, as well as the latest testing and treatment recommendations.
- Nursing Homes and Assisted Living (Long-term Care Facilities) is a website for clinical professionals, residents and their families. Resources include a number of fact sheets, guidelines and toolkits that address infection control and prevention.
- Core Elements of Antibiotic Stewardship for Nursing Homes provides nursing facilities with resources for developing an effective antibiotic stewardship program.
- Influenza (Flu) is a comprehensive resource for influenza-related information.
- Hand Hygiene in Healthcare Settings provides healthcare workers and their patients with helpful information, including hand hygiene guidelines, self-assessment tools and other educational resources.
- Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit will help facilities develop interventions to prevent infections caused by CRE.
Statewide Program for Infection Control & Epidemiology (SPICE)
- Competency for Proficient Infection Preventionists can be used to document the ongoing competency of the facility’s Infection Prevention and Control coordinator/Infection Preventionist.
- Environmental Rounds Worksheet can be used to monitor environmental cleaning and infection prevention practices throughout the facility.
- Hand Hygiene Audit Tool can be used by the Infection Preventionist to monitor compliance with the facility’s hand hygiene policies and procedures.
- Hand Hygiene Competency Validation Tool can be used by the Infection Preventionist to document individual employee’s competency with hand hygiene protocols.
World Health Organization
- WHO Guidelines on Hand Hygiene in Health Care 2009 provides health care workers with evidence-based recommendations for hand hygiene in healthcare settings.
- Five Moments for Hand Hygiene is a graphic representation of the WHO Guidelines for Hand Hygiene in Health Care.
Agency For Healthcare Research & Quality
A Unit Guide To Infection Prevention for Long-Term Care Staff
National Association of County & City Health Officials (NACCHO)
Infection Prevention and Control Resource Library (Provides Best Practices, Tools, Teaching Materials, and specific information just for COVID-19)
ISS Program Basic Overview Webinar
April 27th, 2023
HHSC Long-term Care Regulation will be providing recurring one-hour webinars for Individualized Skills and Socialization providers. These webinars will cover the basics of a license application, and an overview of the survey process.
Additional topics will include reporting abuse, neglect, exploitation or incidents to HHSC. All sessions are duplicates and offer multiple opportunities to facilitate provider attendance.
Friday, April 28
3–4 p.m.
Click here to register.
Monday, May 8
11 a.m.–noon
Click here to register.
Monday, May 22
11 a.m.–noon
Click here to register.
In addition, see following webinar with handout
Did You Miss The Last HCS & TxHmL Town Hall Meeting?
April 14th, 2023
April 12, 2023 town hall meeting
- April topics included:
- Using the Provider Location Update (PLU) Form for moves/updates
- Entering Individualized Skills and Socialization in TMHP
- Highlighting Individualized Skills and Socialization Available Resources
- Questions and Answers – HCS/TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding the LTC Online Portal for HCS and TxHmL.
You can register for the recorded session at: https://register.gotowebinar.com/register/91533672855255893
The next meeting is May 10, 2023. We will keep you posted on registration for this webinar.
Next session they will discuss the “Enrollment Process” and Location Code Issues
Some highlights during the April 13th, 2023 Town Hall Session:
Use the Frequently Asked Questions document:
Frequently Asked Questions Home and Community-based Services (HCS)
Texas Home Living (TxHmL) Waiver Programs
2022 Cost Reporting:
➢WHERE: 2022 Cost Report Units of Service Information for HCS and TxHmL Programs
➢HOW: 2022 Cost Report Units of Service Tool Information for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs
➢WHO: Contact PFD-LTSS@hhs.texas.gov or (737) 867-7817, if there are questions after reviewing the above notifications
▪Refer to the HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 19 notification for updates including avoiding overbilling for service components limited to 1 unit per day, valid IMT suspension reasons for temporary discharge and billable units on IPC form accommodation for leap year.
❑ BEST PRACTICE: Download and reconcile R&S Reports on a weekly basis, as a claim is reported only once in the Non-Pending section of the R&S Report, after it is finalized.
Purpose of PLU Form (Provider Location Update)
3) To End location: •Used when the location does not have any residents and needs to be closed. •Ensure all individuals have been assigned to a new location before ending a location. If a service location is ended by the provider, it cannot be reopened. •The provider must add the ended location as a new location to reopen it.
Avoiding delays in billing when submitting forms for transferred clients
BEST PRACTICE: Review the data auto-populated on the subsequent form (especially the Program Provider section) to ensure that the correct provider is displayed.
Common Location Submission Issues
b)In the event you are still not able to change the effective date, then, you can reach out to UR if this was related to a renewal/ revision. Or reach out to PES if it was related to a transfer.
2. Handling PLU forms that are in ‘Pending Dads Review’ status. •Just like any other forms in this status, HHSC will need additional documentation.
For PLU, supplemental documentation must be submitted by email to Survey Operations at HCSFourPersonResidenceRequests@hhs.Texas.gov
3. Location Capacity issues with submitted forms:
•This will prevent the forms from being stuck for a long time till the verification is complete.
For information on Provider Training, Webinars, Resources, and more
see:
•Texas Health and Human Services Individualized Skills and Socialization website
•Send HCS/TxHmL/DBMD Policy Individualized Skills and Socialization
Questions to: HCSPolicy@hhs.Texas.gov , TxHmLPolicy@hhs.Texas.gov ,or DBMDPolicy@hhs.Texas.gov
•Send Licensure Policy and Rules Questions to:
LTCRPolicy@hhs.Texas.gov
Things to know before billing ISS:
1) You will be authorized for 1,560 hours (max) during an IPC year.
2) Can only bill up to six hours per calendar day.
3) Can only bill five days per calendar day. (Although you can trade out weekend days for equal amount of weekdays, i.e. Mon, Tues, Weds. Sat and Sun.)
4) Cannot date span on claims.
5) Must use HCPCS code H2014 and bill per hour.
6) Use the bill code crosswalk to see the codes and modifiers needed for the particular Individualized Skills and Socialization service.
7) Rate information can be found at this website Long term Services & Supports |Provider Finance Department (texas.gov) Select the appropriate Service from the left side menu.
ISS Units
•Individual Skills and Socialization is an hourly unit, max 1560
•260 DH days= 1560 ISS hrs
•1560 (max) covers the extra day for Leap Year
As of January 1, 2023, you will automatically get Individualized Skills and Socialization
authorization if you were already getting day habilitation authorization.
•This information can be verified on the MESAV.
•These units for individualized skills and socialization will not be visible on the current
IPC form nor on the dashboard until a revision or renewal IPC is entered.
You will first need to submit a Revision IPC to end Day Hab.) Once the revision is in a ‘Processed/Complete’ status, then the Transfer IPC can be submitted.
Tips for data entry
•Make changes on IPC/Cost tab
Prorating
205 X 6 = 1230
TMHP Training Resources For HCS/TxHmL Providers (Videos, FAQ’s, Quick Check Guides, CBT training)
April 11th, 2023
**Please also check the HCS/TxHmL joint training website from HHSC, for periodic related webinars.
Training Resources
(Videos, FAQ’s, Quick Check Guides, CBT training)
It is highly recommended that program providers, LIDDAs, and FMSAs create a TMHP Learning Management System (LMS) account at learn.tmhp.com to access current training related to the LTC Online Portal and claims submissions. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage or email TMHP Training Support for help creating an LMS account or navigating the LMS.
Suggested training resources include:
- HCS and TxHmL Waiver Programs Frequently Asked Questions
- Long-Term Care (LTC) Online Portal Basics Computer-based Training (CBT)
- TexMedConnect for Long-Term Care (LTC) Providers CBT
- Remittance and Status (R&S) Reports for LTC Providers Quick Reference Guide (QRG)
- Claim Appeals for Medicaid CBT
- TMHP Claims Video
- TMHP Account Setup for HCS and TxHmL Waiver Programs QRG
- Long-Term Care (LTC) User Guide for Online Portal Basics, General Information, and Program Resources
- Long-Term Care (LTC) User Guide for TexMedConnect
For more information, email tmhptrainingsupport@tmhp.com
HCS & TxHmL TMHP YouTube Video Playlist
Reminder of New HCBS Rules (HCS & TxHmL): TAC Title 26, Part I Ch. 262 & 263
April 4th, 2023
New HCBS Rules (HCS and TxHmL)
These new HCS rules have been added as TAC Title 26, Part 1, Chapter 263.
Texas Home Living HCBS regulations for compliance requirements is the following TAC title 26 part I Chapter 262
HCS/TxHmL Resources: ISS Provider in San Antonio
March 30th, 2023
I wanted to share the website for one of the ISS providers in the San Antonio area as they do also offer competitive employment for individuals and have employment assistance (EA) and supported employment (SE). Hope this is a good resource from some HCS/TxHmL providers in their area.
https://www.texasfoundationofhope.org/
(210) 265-3351
Office Hours:
Monday – Friday 9:00 AM to 5:00 PM
HCS TAC 9.174 (23) Service Delivery: On-Site Residential Expectations Including Hot Water Temps & Locks On Bedroom Doors
March 30th, 2023
Review of this important section in 9.174 Service Delivery
9.174 (23) (concerning HH/CC, RSS, SL on-site expectations including locks on bedrooms and hot water temps in the home)
(23) ensure that, for an individual receiving host home/companion care, residential support, or supervised living:
(A) the individual lives in a home that is a typical residence within the community;
(B) the residence, neighborhood, and community meet the needs and choices of the individual and provide an environment that ensures the health, safety, comfort, and welfare of the individual;
(C) there is a sufficient supply of hot water at sinks and in bathing facilities to meet the needs of individuals;
(D) the temperature of the hot water at sinks and bathing facilities does not exceed 120 degrees Fahrenheit unless the program provider, in accordance with subsection (i) of this section, conducts a competency-based skills assessment evidencing that all individuals in the residence can independently regulate the temperature of the hot water from the sinks and bathing facilities; (see hot water assessment form from HHSC)
(E) unless contraindications are documented with justification by the service planning team, the individual lives near family and friends and needed or desired community resources consistent with the individual’s choice, if possible;
(F) the individual or LAR is involved in planning the individual’s residential relocation, except in the case of an emergency;
(G) unless contraindications are documented with justification by the service planning team, the individual has a door lock on the inside of the individual’s bedroom door, if requested by the individual or LAR; and
(H) the door lock installed in accordance with subparagraph (G) of this paragraph:
(i) is a single-action lock;
(ii) can be unlocked with a key from the outside of the door by the program provider; and
(iii) is not purchased and installed at the individual’s or LAR’s expense;
ISS Service Delivery Logs -Update
March 30th, 2023
Service Delivery Logs for Individualized Skills and Socialization
As of March 14th, 2023, information from the HHSC ISS SDL website page:
Form 8615, On-site and Off-site Individualized Skills and Socialization Service Delivery Log, and Form 8616, In-Home Individualized Skills and Socialization Service Delivery Log, are no longer mandatory to document a service claim of on-site, off-site, or in-home individualized skills and socialization.
A program provider may develop their own service delivery logs or use an electronic health record system to document individualized skills and socialization. All elements from Form 8615 and Form 8616 must be included in any documentation developed.
For each service event the service delivery log must include the following elements:
- Individual’s name
- Name of the individualized skills and socialization provider
- Individualized skills and socialization Provider License Number
- Date of service
- Time in and time out for each service event
- Location
- Description of billable activities
- Name and signature of service provider
For off-site service delivery logs, in addition to the information above for each service event, the elements that must be documented include:
- Individual’s level of need (LON)
- Ratio or approved enhanced staff rate
- Number of individuals being served by the service provider during the service event
- Name and address of community location(s) visited during the off-site service event
- Name and signature of the service provider
For in-home service delivery logs, in addition to the information for each service event, the elements that must be documented include:
- Staff ID as assigned by the program provider (meaning the HCS/TxHmL program provider)
HHSC will update Form 8615 and Form 8616 to provide Spanish-language versions. Any submission of forms containing information that is not in English will need to comply with 26 TAC §263.7.
For providers who use Form 8615 and Form 8616, HHSC has provided clarification below:
Form 8616 and Form 8615 are only required to document service events for individuals in the HCS and TxHmL Programs. (Does not include DBMD program)
In the off-site section of the form:
- “Ratio” refers to the ratio for the individual as required by 26 TAC §263.2017 (HCS) or 26 TAC §262.917 (TxHmL).
- “Staff” would equal one.
- “Individuals” refers to the total number of individuals or other persons receiving services assigned to a service provider during a service event. This does not include any identifying information. *Persons outside of the HCS and TxHmL Programs, receiving a similar service, must be included in the number of individuals for the delivery of off-site individualized skills and socialization.
Form 8615 and Form 8616 were developed to document a service event for on-site, off-site, or in-home individualized skills and socialization. Program providers may request additional information or documentation from an individualized skills and socialization provider to obtain updates on the progress or lack of progress towards an individual’s goals.
The days of the week included on Form 8615 and Form 8616 may be altered if an individual receives individualized skills and socialization on a Sunday or Saturday. The program provider must ensure that an individual does not exceed the service limit of five days per calendar week (Sunday–Saturday).
Each service event must have an exact time in and time out and all documented elements. The total amount of time providing the service each day cannot be combined into one service event for that date.
If a program provider chooses to complete Form 8615 or Form 8616 electronically, it must be in compliance with 40 TAC §49.305(j) related to a contractor using electronic records.
For questions about this alert or the service delivery logs for individualized skills and socialization, email HCSPolicy@hhs.texas.gov.
March 1st, 2023
ISS Service Delivery Logs (SDL’s) & Electronic Health Record (EHR) systems
February 21st, 2023
Service Delivery Logs Finally Available for Individualized Socialization Skills Services
INSTRUCTIONS: Updated: 2/2023
Purpose
Form 8615 is used by Texas Health and Human Services Commission (HHSC) staff, as well as Home and Community-based Services (HCS) and Texas Home Living Service (TxHmL) Waiver program providers to document a service event for on-site and off-site individualized skills and socialization.
Procedure
When to Prepare
Form 8615 must be completed within 14 calendar days after the activity being documented is provided.
Form Retention
The program provider must maintain a copy of the completed Form 8615 in the individual’s record.
General Instructions
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Form 8615 must be used for only one individual.
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Form 8615 may be used for multiple billable service events. Each billable service event must have a begin and end time.
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Form 8615 is considered a Medicaid document used for Medicaid purposes. By using this form, you understand it is your responsibility to record accurate information, as this information may be subject to a court of law. Failure to record accurate information or deliberate falsification of documentation is strictly prohibited.
Detailed Instructions
Individual Name — Enter the individual’s name.
Place of Service(s) — Enter the address at which the billable activity occurred.
Level of Need — Enter the individual’s level of need.
Name of Individualized Skills and Socialization Provider — Enter the name of the entity.
Individualized Skills and Socialization Provider License Number — Enter the license number of the individualized skills and socialization provider.
Date and Days of the Week — Enter the date (month, day, year) when the billable activity occurred.
Time In — Enter the time when the billable activity started.
Time Out — Enter the time when the billable activity ended.
Name of Service Provider — The printed name of the service provider who provided the service event for on-site or off-site individualized skills and socialization.
Service Provider Signature — At least one service provider who provided the service event for on-site or off-site individualized skills and socialization must sign the form. If more than two service events occur in a calendar day, the service provider must complete a new Form 8615.
Initial all areas in which you assisted the person — Initial the box that corresponds to activities provided by the service provider. The services initialed must justify amount of time spent providing services. A minimum of one activity must be marked for a billable service claim to have occurred.
Community Locations Visited and Special Events or Occurrences — This field is required to identify the location(s) for off-site individualized skills and socialization and may be used to document special events or occurrences. If providing written documentation, enter the date on which the billable activity occurred and the staff initials.
Initials — Enter the initials of the service provider(s) providing billable activities to the individual.
Questions
To inquire about Form 8615 or instructions, email hcspolicy@hhs.texas.gov.
TMHP: Where Do HCS/TxHmL Providers Go To Find The Information To Complete Their Cost Reports For 2022?
HHSC’s Response to Some Of The Questions Concerning Cost Reports for 2022:
The HCS/TxHmL Units of Service Look-up tool was created at the providers’ request to assist them in completing the 2022 cost report. Providers have questioned whether it captures all that is needed for the cost report and if HHSC is responsible for ensuring there is an appropriate report page for providers to collect this information in TMHP and/or Texas Med Connect.
HHSC has stated that Providers may rely on their own billing records to complete their required reports in accordance with the Title 1 of the Texas Administrative Code (1 TAC) and cost report instructions, etc. The provider must certify that the information included in the cost report is accurate. As a reference, 1 TAC Section 355.102(c) states:
Accurate cost reporting is the responsibility of the contracted provider. The contracted provider is responsible for including in the cost report all costs incurred, based on an accrual method of accounting, which are reasonable and necessary, in accordance with allowable and unallowable cost guidelines in this section and in §355.103 of this title, revenue reporting guidelines in §355.104 of this title (relating to Revenues), cost report instructions, and applicable program rules. Reporting all allowable costs on the cost report is the responsibility of the contracted provider. The Texas Health and Human Services Commission (HHSC) is not responsible for the contracted provider’s failure to report allowable costs; however, in an effort to collect reliable, accurate, and verifiable financial and statistical data, HHSC is responsible for providing cost report training, general and/or specific cost report instructions, and technical assistance to providers. Furthermore, if unreported and/or understated allowable costs are discovered during the course of an audit desk review or field audit, those allowable costs will be included on the cost report or brought to the attention of the provider to correct by submitting an amended cost report.
Regarding concerns about the data provided in HHSC’s units of service look-up tool, information letter 2023-12 clarifies:
HHSC will be updating the record of paid units of service before beginning the financial examination of the 2022 cost reports. This timing will allow cost reports to be revised based on any paid claims adjudicated after the 2022 cost report was submitted. HHSC PFD’s Cost Report Review Unit (CRRU) financial examiners will work individually with the provider and cost report preparer if there are material variances between the units reported and the updated paid claims data.
Regarding concerns about the unit totals and not reflecting units that have not been paid, information letter 2023-12 clarifies:
Providers must report, on an accrual basis, paid units of service delivered during their 2022 cost reporting period in Step 5 on the cost report. Providers should report units of service for each waiver service by the level of need delivered during their cost reporting period and paid by the time the cost report is submitted. Any units of service delivered during the cost reporting period, but not paid by the time the cost report is submitted, should be reported as a non-reimbursed unit. HCS and TxHmL providers should report all allowable costs incurred during their cost reporting period for paid and non-reimbursed units of service.
Regarding concerns about additional training or a webinar:
HHSC is incorporating training related to accessing and using the units of service look-up tool in upcoming cost report trainings and is working on publishing recorded instructions to assist providers with using the tool. A Gov Delivery will be published when this information is made available.
HHSC encourages any provider who has questions about the tool to contact HHSC Provider Finance at PFD-LTSS@hhs.texas.gov for assistance.
Regarding requests for cost report extension:
HHSC is not granting cost report extension at this time outside of the 15-day extension established in accordance with 1 TAC Section 355.111.
Remember providers to submit 2022 cost reports prior to May 1st, 2023. Cost reports are due April 30, 2023.
The lookup tool will include any units paid through the Client Assignment and Registration (CARE) and Texas Medicaid & Healthcare Partnership (TMHP) claims systems during the cost reporting period.
Please refer to Information Letter 2023-12 for more information on how to obtain the lookup tool and report units of service on the 2022 cost report.
Please refer to our Cost Reporting Training webpage for the 2022 Cost Report Unit of Service (UOS) Tool Webinar demonstration on how to obtain the lookup tool and report units of service on the 2022 cost report.
If you have questions after reviewing the Information Letter, please contact PFD-LTSS@hhs.texas.gov or (737) 867-7817.
Heightened Scrutiny: Process For ISS
March 29th, 2023
Heightened Scrutiny Process For ISS (Individualized Skills and Socialization)
Individualized skills and socialization has replaced day habilitation in these programs: HCS, TxHmL & DBMD. Individualized skills and socialization will include an on-site component and an off-site component.
The heightened scrutiny process will be required if a setting in which on-site individualized skills and socialization is provided:
(1) is located in a building in which a state supported living center or a certified intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID) operated by a LIDDA is located but is distinct from the state supported living center or the certified ICF/IID operated by a LIDDA;
(2) is located in a building that is on the grounds of or immediately adjacent to a state supported living center or a certified ICF/IID operated by a LIDDA;
(3) is located in a building in which a licensed private ICF/IID, a hospital, a nursing facility, or other institution is located but is distinct from the ICF/IID, hospital, nursing facility, or other institution;
(4) is located in a building that is on the grounds of or immediately adjacent to a hospital, a nursing facility, or other institution except for a licensed private ICF/IID; or
(5) has the effect of isolating individuals from the broader community of persons not receiving Medicaid HCBS.
If heightened scrutiny is required, a provider must complete the heightened scrutiny process and receive written approval from HHSC before submitting an application to become licensed as a day activity and health services facility with a special designation for individualized skills and socialization.
Read more about the heightened scrutiny process for individualized skills and socialization in Information Letter 22-53, Requirements for Providers Seeking to Deliver New Individualized Skills and Socialization Services (PDF).
Questions
If you have questions about the heightened scrutiny process or whether it applies to you, email MCS_Heightened_Scrutiny_Review@hhs.texas.gov.
Info Concerning Medicaid HCBS Settings Compliance Requirements Including CMS Toolkit
March 26th, 2023
HHSC published PL 2023-06 Compliance with New HCBS Settings Rules
HHSC Long-term Care Regulation published Provider Letter 2023-06 regarding Compliance with New HCBS Settings Rules on March 24, 2023. This letter explains how LTCR surveyors will assess HCS providers for compliance with the new HCBS settings requirements.
March 15th, 2023
The Center for Medicaid and CHIP Services (CMCS) is sharing this toolkit with State Medicaid Agencies, Operating Agencies, and other stakeholders a Home and Community-Based Settings Toolkit to assist states to develop Home and Community-Based 1915(c) waiver and 1915(i) SPA amendment or renewal application(s) to comply with new requirements.
Texas State Transition Plan for CMS’s HCBS Compliance Requirements (2022 update)
These requirements were noted in the recently published Home and Community-Based Settings (HCBS) regulations. HHSC is amending TAC rules to add requirements for all settings in the HCS program, including 3-person and 4-person group homes and host home/companion care settings, to comply with HCBS settings requirements at 42 CFR §441.301(c)(4)(i)-(v).
These new HCS rules have been added as TAC Title 26, Part 1, Chapter 263.
Texas Home Living HCBS regulations for compliance requirements is the following TAC title 26 part I Chapter 262
I would pay attention, in particular to the following information in the toolkit: Info on residential & non-residential settings, Q&A for HCBS, Transition Plan toolkit, and the info on Heightened Scrutiny and the Review process for it, as well as person-centered requirements.
Handy Dandy List of Items In The Toolkit:
- SMDL: Home and Community-Based Settings Regulation – Implementation Timeline Extension and Revised Frequently Asked Questions – July 14, 2020
- March 2019 Updated Frequently Asked Questions on Heightened Scrutiny Provisions
- July 2019 CIB: Heightened Scrutiny Review of Newly Constructed Presumptively Institutional Settings
- All State Call Slides: FAQs on Heightened Scrutiny – March 2019
- FAQs concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior
- A summary of the regulatory requirements of fully compliant HCB settings and those settings that are excluded.
- Schematic drawings of the heightened scrutiny process as a part of the regular waiver life cycle and the HCBS 1915(c) compliance flowchart.
- Additional technical guidance on regulatory language regarding settings that isolate.
- Exploratory questions that may assist states in the assessment of:
- Questions and Answers Regarding Home and Community-Based Settings
- Statewide Transition Plan Toolkit for Alignment with HCB Settings Regulation Requirements Suggestions for alternative approaches and considerations for states as they prepare and submit Statewide Transition Plans for the new federal requirements for residential and non-residential home and community-based settings. The regulatory requirements can be found at 42 CFR 441.301(c)(4)(5) and 441.710(a)(1)(2).
- Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information
- Frequently Asked Questions on Planned Construction and Person-Centered Planning Requirements
Bills Submitted During Texas’s 88th Legislative Session
March 20th, 2023
88th Legislative Session in Texas!
Here Are A Few House Bills Submitted That May Affect Long-Term Care & Other Services For Persons With Disabilities
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HB 54: Personal needs allowance for certain Medicaid recipients who are residents of long-term care facilities.
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HB 144: Possible Exemption from ad valorem taxation of the total appraised value of the residence homestead of an unpaid caregiver of an individual.
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HB 166: The appointment of an educational representative for certain students with disabilities.
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HB 245: Community attendants under the community attendant services program.
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HB 568: Education and training for peace officers on interacting with persons with Alzheimer’s disease and other dementias.
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HB 653: Guardianships of the person of wards with profound intellectual disabilities who are minors or were minors when their guardianship proceedings commenced.
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HB 1430: Establishing a minimum wage for certain personal attendants under Medicaid and other programs administered by HHSC (One can only hope this means an increase in funding for wages!)
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HB 1593: Infection prevention and control programs and other measures for communicable diseases at certain long-term care facilities.
See more info on House Bills and Senate Bills in the PDF links below.
*Note: Each bill provides a link to the text of the bill. After clicking on the link, click on ‘text’. Under ‘Text’ you will find the bill as filed and various versions of the bill as it makes its way through the committee process and moves from one chamber to the other. Bills highlighted in yellow are deemed ‘priority’ bills.
1-Day Live Training- Austin, Tx- Introduction To ISS (Individualized Skills & Socialization) April 3rd, 2023
Individualized Skills and Socialization Joint Training Opportunities
For: Applicants For ISS Licensure and New ISS Providers
HHSC Joint Provider Trainings will host a 1-day live training (Austin, Tx) that will cover the licensing process for the Individualized Skills and Socialization Program, as well as an overview of the rules, survey process, and reporting requirements for allegations of abuse, neglect, and exploitation.
Introduction to Individualized Skills and Socialization Program (course description)
701 W. 51st Street
Room: Public Hearing Room
Austin, TX 78751
(150 MAX)
1915(c) Waiver Interest Lists: Find By Legislative Districts
March 5th, 2023
Thanks to our friends at ARC for posting this in one of their recent newsletters
1915(c) Waiver Interest Lists by Legislative District
Find below maps produced by The Arc of Texas showing how many Texans on Medicaid waiver interest lists live within each State House, State Senate, and Congressional district. The Medicaid waivers being tracked are all CLASS, DBMD, HVC, MDCP, STAR+ PLUS, and TXHML.
The darker the hue of the district, the more people there are on any interest list in that district.
Each district’s label indicated the current incumbent in that district.
Clicking on each district with show more detailed information.
Letter IL 2023-09: Host Home Provider’s Who Are Immediate Family Members & New CMS Rules For HCS
February 27th, 2023
Letter IL 2023-09 discusses that Sections 263.502 and 263.503 (a)(1)(A) and (b) through (m) of the new Chapter 263 CMS rules do not apply to HH/CC providers in which the HH/CC provider is an immediate family member of the person receiving HH services. See page 1, 2nd paragraph of the IL for the definition of an immediate family member. Sections 263.502 and 23.503 (a)(1)(A) and (b) through (m) will however, apply if a HH/CC provider does not meet the definition of an immediate family member
Under Chapter 263, Subchapter F related to Provider Owned or Controlled Residential Settings, in particular Sections 263.501, 263.510 and 263.503. The rules under these sections address the following: requirements related to HCBS settings (Section 263.501); requirements as to what providers must ensure in the delivery of services, such as privacy in bedrooms, an operable bedroom door lock, access to food, choice of roommates, etc. (Section 263.502); and requirements related to residential lease agreements (Section 263.503).
HCBS Settings Rules Adopted for HCS, TxHmL & TAS (Transition Assistance Services)
February 25th, 2023
- Only the rule provisions to which changes were made are included in the links above. I believe HHSC will post the complete set soon.
- You are urged to read the preamble to the rules, in particular HHSC’s responses to comments received from stakeholders, before reading the rules.
- See pages 74 through 81 in the HCS rules for the adopted rules governing Residential Settings and Residential Agreements.
PHE (Public Health Emergency) & New ISS Services
February 22nd, 2023
I know providers have really been concerned about the period of time between March 1st and May 11th while the PHE has been extended, as to whether or not this will include ISS services for In-Home ISS.
HHSC stated it would release a notice soon stating that beginning March 1, 2023 in-home ISS can be done without the justification (medical or behavioral justification or anyone 55 years of age and older should they request such) for such that will be required in the rules, through May 11th. After May 11th, however, this will not be permitted anymore and the justifications for in-home ISS must be in place.
***Remember medical and behavioral justifications will require medical recommendations or orders from physician and/or behavioral support professional recommendations (i.e. psychologist, bcba)
In-Home ISS in Host Home Companion Care (HH/CC) Settings: Update
February 22nd, 2023
In-Home ISS in HH/CC Settings: If persons receiving HH/CC services receive in-home ISS only, the provider does not have to be licensed. If the person receiving HH/CC services engages in community activities (known as off-site ISS), then the provider of the off-site ISS must be a licensed ISS provider.
Modifications to CMS Regs HCBS Settings Rules: Access To Food, Locks On Individual’s Doors & More
February 21st, 2023
Update on Who Qualifies To Assess The Need For A Modification
According to HHSC (and the proposed rules that will now be under Chapter 263) modifications to the door lock requirement must be based on a documented, assessed need and brought to the SPT for review and documentation in one’s PDP
As to whom determines the assessed need, HHSC stated at recent training sessions in Lake Jackson and Austin I believe, that a licensed professional, defining such as a doctor, RN, behavioral health provider, or other therapist providing such determination is within the scope of their practice.
February 14, 2023
Protocol For Modifications to AccessTo Food, Locks on Individual’s Doors & Other CMS Regs HCBS Settings Rules
Please see the alert letter below for complete information discussed in this post:
“In 2014, CMS issued federal regulations for settings where Medicaid home and community-based services (HCBS) are provided. All settings where Medicaid HCBS are delivered must meet federal requirements by March 17, 2023.
HHSC is finalizing updates to the HCS Program rules at 26 TAC §263.502. The rules are expected to be adopted in early 2023 and will include the detailed requirements outlined below.
The federal regulations require that all individuals residing in a provider-owned or controlled setting must ensure certain requirements are met. These requirements include:
● Individual privacy in the bedroom;
● Choice not to share a bedroom;
● Choice of roommate if sharing a bedroom;
● A lock is installed on the bedroom door;
● Individual can furnish and decorate their bedroom;
● Individual has control over their schedule and activities that are not part of an implementation plan;
● Individual has access to food at any time;
● Individual has the ability to have visitors of their choosing at any time;
If a program provider becomes aware that a modification to one of these requirements must be implemented due to a specific assessed need of an individual, the program provider must notify the service coordinator as soon as possible. The program provider must provide the service coordinator with the following information:
● A description of the specific and individualized assessed need that justifies the modification;
● A description of the positive interventions and supports that were tried but did not work;
● A description of the less intrusive methods of meeting the need that were tried but did not work;
● A description of the condition that is directly proportionate to the specific assessed need;
● A description of how data will be routinely collected and reviewed to measure the ongoing effectiveness of the modification;
● The established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;
● The individual’s or legally authorized representative’s (LAR’s) signature evidencing informed consent to the modification; and
● The program provider’s assurance that the modification will cause no harm to the individual.
If the service coordinator receives a notification from the program provider of a required modification(s), the service coordinator must convene a service planning team (SPT) meeting to update the person-directed plan (PDP) with the information above.
If the SPT agrees to the modification(s) and updates the PDP, then the program provider may implement the modification(s).
**Note that a family member/LAR’s request or preference to not comply with one of the requirements is not considered an individualized assessed need that justifies a modification to the federal requirement.”
Link to PowerPoint Handout From Austin Training on February 10th, 2023 for information discussed on this subject and other current issues (residential agreements, ISS, etc…)
Repeal of HCS Rules under Title 40, Chapter 9 / Movement to Title 26, Chapter 565
February 14th, 2023
Repeal of HCS Rules under Title 40, Chapter 9 / Movement to Title 26, Chapter 565
An additional concern from HCS program providers involves their ability to comply with the regulations without financial support from HHSC. Program providers expressed that both existing requirements that will transfer to new Title 26 and new requirements added to improve health and safety create an undue financial burden given the current reimbursement rate structure within the Medicaid HCS waiver program. Program providers and advocates also expressed a desire for interpretive guidance to ensure accurate implementation from both a provider and surveyor perspective.
HHSC worked closely with HCS program providers and advocacy groups while creating these rules to attempt to mitigate their concerns regarding cost of implementation and clarity of rules language. HHSC also agreed to develop interpretive guidance once rules are adopted to ensure consistent application from providers and surveyors. During the year-long workgroup process, HCS program providers, advocacy groups, and HHSC staff crafted health and safety language that all parties agreed would meet the needs of the individuals who receive HCS waiver program services.
In March 2021 through February 2022, HHSC met with HCS providers associations, including PPAT, PACTX, and Texas Council for Community Centers; advocacy groups, including Disability Rights Texas and Every Child; and HHSC program staff. This workgroup focused on creating clear and concise rule language dedicated to the health and safety of the individuals who receive HCS waiver program services. HHSC held monthly workgroup meetings to review existing HCS regulations and create revised HCS regulations, with the focus on health and safety. Workgroup participants provided feedback both during and between meetings by providing feedback on proposed language. The workgroup received the complete draft regulatory language in February 2022 and provided input prior to beginning the formal rulemaking process.”
- Target date for publication in the Texas Register: February, 2023.
- Target date for adoption: May 2023.
- See pages 1-3 for Background Information.
- See pages 4 – 8 for Preamble to repeal of rules under Chapter 9.
- See page 9 for Preamble to the proposed new rules which provides a high-level summary of changes.
- See pages 16 – 106 for proposed new rules.
- See pages 73 – 74 for Residential Requirements, including provisions related to locks on bedroom doors. These proposed rules contradict the proposed HCBS settings rules under Chapter 263 regarding locks. [Though confirmation is being sought, it was reported that at the ISS and HCBS training HHSC conducted in Austin last Friday, HHSC stated the rules under Chapter 263 (which are still not adopted) will take precedence.
- See page 78 for provisions related to the new requirement for conducting quarterly on-site visits in HHs.
- See bottom of page 81 for requirements related to Finances and Rent.
PAT: Provider Applicant Test-Update 2023
February 10th, 2023
From HHSC’s PAT FAQ’s as of Jan. 1st, 2023
“Frequently Asked Questions for Providers Applicant Training (PAT) for HCS/TXHML”
-When is the Provider Applicant Training (PAT) Online available?
This training is now available online. The PAT training is the first step for applicants to obtain a contract with HHSC. Please do not submit your application without the PAT certificate that reflects a passing score of 85% or above.
-Who can take the training?
Applicants listed on Form 3681, Section 8.a and 8.b must complete the online PAT training. The Program Manager listed must complete the training and pass the test with an 85% or above.
See Texas Administrative Code Title 40, Chapter 49, Rule §49.204.
-How can I access the HHS Learning Portal?
• HHS Learning Portal (texas.gov).
• Set up your new account. You will need to confirm your new account through the email address used.
• Find and select the Medicaid Long Term Services and Support Training under “Course Categories.”
• Select the Provider Applicant Training (PAT) link. Select “Enroll me” to access the Training and get access to the “Welcome” page.
The training is compiled in four different steps.
Step 1. Important to know Before you Get Started
Fill out the Provider Applicant Training (PAT) Information form. This form must be completed to access the introduction and the training modules.
Step 2. Training Modules
Complete each module must be completed to advance to the next module.
Step 3. Evaluation and Certificates
Complete the mandatory survey
Step 4. Provider Competency Exam
Download, and save your exam certificate upon completion. Submit the certificate along with your completed application
IMPORTANT: You must take the PAT before you can apply to be an HCS Provider!!!. You must pass the Test by 85 % If you fail the test, you can’t retake the test for a period of 6 months, so please study the TAC before and pay careful attention to the PAT modules before answering test questions.
Note: If you do not pass on your first attempt, please DO NOT apply.
Important: Re-evaluation of Medicaid Eligibility!!
March 2nd, 2023
Unwinding of Continuous Medicaid Coverage: HHSC will stagger Medicaid Eligibility Determinations, separating into 3 groups. IDD will be in the last group, meaning that packets will be sent in June with persons having 30 days to reply. More information can be found at: https://www.hhs.texas.gov/services/health/coronavirus-covid-19/coronavirus-covid-19-provider-information/end-continuous-medicaid-coverage-ambassador-toolkit
February 9th, 2023
The Biden administration plans to end the state of Public Health Emergency (PHE), due to the pandemic. Many are warning that the shift will have major implications for people with disabilities that go far beyond COVID-19.
Under the public health emergency, which has been in place since 2020, states have been eligible for extra federal funding for Medicaid in exchange for agreeing not to drop most beneficiaries from the program. The federal government has also given HCS providers added flexibilities during this time.
Currently, it appears that President Biden plans to extend the public health emergency to May 11, at which point it will end.
Once the PHE is over, it will trigger a widespread effort by Medicaid programs across the country to re-evaluate each beneficiary (in this case, meaning individuals in our IDD programs) to determine whether or not they remain eligible. Many are worried that quite a few persons with developmental disabilities could inadvertently or accidently be dropped from the program, even if they still qualify. In addition, if they lose Medicaid eligibility even temporarily due to this issue, it will make it much harder to reverse the decision in a timely fashion. This would affect providers in receiving funds for their services provided to individuals. It would also mean that these individuals would not be able to obtain HCS services possibly anymore as they would not qualify for the waiver and they would not be able to receive their medical care and medications through Medicaid.
I can’t stress enough, that people with disabilities and their families (or specific Medicaid contact person) make sure they respond to any mail or email from their Medicaid office, that their address is up to date at HHSC & Medicaid as well as being in compliance with the financial eligibility rules under Medicaid as well. Be sure to fill out any annual Medicaid Status Reports on time as well.
If an IDD provider (HCS, TxHmL, etc..) is the contact person for Medicaid please have all available persons that are appropriate assist with this process to ensure your individuals do not lose their Medicaid. ( i.e. case managers/care coordinators, program managers, financial dept. staff, etc.)
States can start the redetermination process as soon as this month and can terminate Medicaid coverage for individuals as early as April 1. Across the country, the process is expected to be complete no later than May 2024.
TMHP’s 1915(c) Waiver YouTube Training Videos Website: PEMS (Program Enrollment Management Systems) & More
February 9th, 2023
Where can you find helpful Training Videos on the PEMS process? Check out the TMHP page with their Youtube videos for PEMS.
In addition, you will find information on removing TPI’s and a Video series on running and utilizing your R&S Reports
1915 (c) waiver page at TMHP For YouTube Training Videos
Specific link to R&S Report Video Series
Specific link to Removal of TPI From Forms Video
Proposed HCS and TxHmL Billing Requirements
February 5th, 2023
Proposed HCS and TxHmL Billing Requirements
Home and Community-based Services and Texas Home Living stakeholders can now comment on the proposed revisions to the HCS and TxHmL Billing Requirements by Feb. 14.
The proposed billing requirement revisions and a summary of changes are located on the Long-term Care Providers webpage and are outlined below:
HCS
HCS Billing Requirements Draft Revision 23-2 (MS Word)
HCS Billing Requirements Draft Revision 23-2 Summary of Changes (PDF)
TxHmL
TxHmL Billing Requirements Draft Revision 23-2 (MS Word)
TxHmL Billing Requirements Draft Revision 23-2 Summary of Changes (PDF)
Email stakeholder comments to TxHmL Policy.
IMT and IPC Form Enhancements Pertaining To Location Code Issues in TMHP Now Available!
January 5th, 2023
IMT and IPC Form Enhancements and IBI Guide Updates Now Available
From HHSC:
“On January 13, 2023, a text box replaced the location code drop-down box on the following Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Individual Movement (IMT) and Individual Plan of Care (IPC) form fields:
- IPC transfers (3608/8582) field 39a: Receiving Program Provider Location Code
- IMT (all-purpose codes) field 18: Location Code
- IMT Individual Update fields 122: Current Location Code and 123: New Individual Location Code
- IMT LA Reassignment field 111: New Location Code
The information that is entered manually will be validated upon submission to ensure that the location code is valid for the provider. This enhancement will improve overall system performance.”
***Should be a huge help to getting those transfers through that many have had pending at the LIDDA’s!
The following item-by-item (IBI) guides have been updated to reflect enhancements:
For further information, contact the TMHP LTC Help Desk at 800-626-4117. Select option 1 and then option 7.
ARC Free Resource: Advocacy Toolkit
January 31st, 2023
Advocacy Toolkit from our friends at the ARC of Texas
https://www.thearcoftexas.org/wp-content/uploads/Advocacy-Toolkit.pdf
Twogether Consulting Webinars
February 2023
Common Nursing Violations: Prevention & Correction
February 23rd, 2023 10 AM-12:00 PM
(ICF/IID)
The HCS/TxHmL Interpretive Guidance Booklet: Nursing Focus
February 27th, 2023 11AM-12:30 PM
(HCS/TxHmL)
March 2023
Abuse, Neglect & Exploitation: Definitions, Signs & Symptoms, Reporting
March 2nd, 2023 11 AM-12:30 PM
(HCS/TxHmL)
(This session is for employees, contractors, volunteers, and more)
The CRA (Client’s Responsible Adult) & Their Responsibilities To The Nurse
March 8th, 2023 10 AM-11:30 AM
(HCS/TxHmL & ICF)
RN Delegation: Important Things To Remember
(This session does not cover SB1857/HRC 161 or HH/CC Exemptions)
March 9th, 2023 10 AM-11:30 AM
(HCS/TxHmL & ICF)
Billing Requirement Changes In HCS-2023 Update
March 29th, 2023 10AM-12:30PM
To Be Determined At A Later Date
Abuse, Neglect & Exploitation Allegation Follow-Up Requirements: (HCS/TxHmL Providers)
(This session is for: Administrative Staff, Program Managers, Case Managers/Care Coordinators, Nurses, and Quality Assurance Staff)
Abuse, Neglect & Exploitation Allegation Follow-Up Requirements: (ICF/IID Providers)
(This session is for: Administrators, QIDPs, House Managers, Nurses, and Quality Assurance Staff)
Please Continue To Check The Website For More Trainings
Pre-recorded sessions are available for purchase!
To Purchase these Pre-Recorded Trainings:
Go to www.twogetherconsulting.com
Or
Contact us at Javasbja@gmail.com at Meghanjones.tx@gmail.com
Currently, we have the following pre-recorded sessions:
ICF/IID Pre-Recorded Webinar Sessions
QIDP In The ICF Program (3 Part Series)
Nurse In The ICF Program (3 Part Series)
HCSTxHmL Pre-Recorded Webinar Sessions
Expectations of The Nurse: HCS/TxHmL
(includes: Delegation, CNA Training, Billable Services & Documentation as well) (4 Part Series)
Care Coordination (5 Part Series)
CARE COORDINATION (5 Part Series)
Part I
“Roles & Responsibilities: The LIDDA Vs. The Provider (For HCS/TxHmL providers)
Contact us at info@twogetherconsulting.com to purchase this training and the handouts.
Part II Pre-recorded sessions available for purchase!
“Important Parts of The TAC In Relation To The HCS Handbook” (For HCS/TxHmL providers)
Part III Pre-recorded sessions available for purchase!
For HCS & TxHML Providers
“Developing The IP Using Person-Centered Practices” This is part 3 of 5 of our Care Coordination series.
Part IV Pre-recorded sessions are available for purchase!
“ICAP/IDRC/LON” Webinar This is part 3 of 5 of our Care Coordination series.
Part V Pre-recorded sessions are available for purchase!
(Billable Services- HCS) This session is split up into 2 parts! Each section is 2 to 2.5 hrs long
General Billable Services (Day 1) & then Adaptive Aids/Minor Home Mods/Dental (Day 2)
Contact us at info@twogetherconsulting.com to purchase this training and the handouts.
Migration of In-Home DH to In-Home ISS Update
January 27th, 2023
As of 1/27/23, there have been no new alert letters concerning the extension of temporarily waiving certain requirements for In-Home DH due to the Public Health Emergency, past January 31st, 2023. This was the date we were given in Letter No. 2022-55.
My understanding is providers would receive notice at least 30 days prior to ending the PHE. I am assuming at this time that the PHE will extend through Feb. 28th, 2023. In-Home DH billing will discontinue in TMHP as of March 1st, 2023, so the last day to bill In-Home DH will be Feb. 28th, 2023. At this point, we move to In-Home ISS services. However, if the PHE does not end, I am unclear yet if In-Home ISS will allow for continuing to waive certain requirements temporarily due to the PHE. I believe that due to the fact the allowance for anyone to qualify for In-Home DH during the PHE is not part of the In-Home ISS rules/ISS rules, that an addendum would have to be put in place to cover In-Home ISS due to PHE. Not sure that will happen, so I would plan to be ready by March 1st.
Otherwise, come March 1st, 2023 all individuals wishing to receive In-Home ISS services will have to qualify in the following way:
In-home ISS must be provided in the individual’s residence.
Billing Requirements Section 49102.3
Requirement for Justification by a Licensed Professional or to be 55 Years or Age or Older
Revision 23-1; Effective January 1, 2023
An individual may receive in-home individualized skills and socialization only if:
(a) a physician has documented that the individual’s medical condition justifies the provision of in-home individualized skills and socialization; or
(b) a licensed professional or behavioral supports service provider listed in Section 4240(2), Qualified Service Provider, has documented that the individual’s behavioral issues justify the provision of in-home individualized skills and socialization; or
(c) the individual is 55 years of age or older and requests to receive in-home individualized skills and socialization.
In addition, EVV will need to occur for In-Home ISS services.
Qualifications for Service providers of In-Home ISS are as follows (they don’t need to be licensed)
49102.8 Qualified Service Provider
Revision 23-1; Effective January 1, 2023
In addition to meeting the requirements in Section 3400, Qualified Service Provider, a qualified service provider of the in-home individualized skills and socialization service component;
- (a) must have: (1) one of the following:
- (A) a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma; or
- (B) documentation of a proficiency evaluation of experience and competence to perform the job tasks that includes:
-
- (i) a written competency-based assessment of the ability to document service delivery and observations of the individuals to be served; and
- (ii) at least three written personal references from persons not related by blood that indicate the ability to provide a safe, healthy environment for the individuals being served; and
(b) must not be the individual’s host home/companion care service provider
November 21, 2022
Letter No. 2022-55 (Replaces IL 2022-54)
This information letter (IL) replacesd IL 2022-54 In-Home Day Habilitation Information for Program Providers for COVID-19, previously released on October 31, 2022, to extend the temporary guidance through January 31, 2023, unless the COVID public health emergency ends sooner. HHSC will provide guidance if anything changes.
In response to COVID-19 and to provide access to needed day habilitation services, the Health and Human Services Commission (HHSC) is temporarily waiving certain requirements in Sections 4381.3, 3710, 4381.7(6) and 4381.7(7) of the HCS Billing Guidelines and the TxHmL Billing Guidelines.
Effective March 13, 2020, through January 31, 2023 unless the COVID PHE ends sooner:
● HCS or TxHmL program providers may provide day habilitation to an individual in the individual’s permanent or temporary residence without having the justification required by Section 4381.3. This includes individuals residing in their own homes or family homes.
For more info, please click on the information letter.
HHSC Form 4719 Required for Fire Drills for ISS Providers
January 27th, 2023
HHSC Form Required for Fire Drills for ISS Providers
Click on link below
* Some providers have noted that this form seems a bit inappropriate for ISS providers as the form has locations that seem more appropriate for a “home” setting, as opposed to maybe a “building” used by a licensed ISS provider, but it does have a box for “other” locations.
STATEWIDE TRANSITION PLAN: HCBS
January 16th, 2023
Statewide Transition Plan
CMS requires states to submit a transition plan describing the state’s planned initiatives and activities for achieving compliance with the federal HCBS Settings Rule. HHSC has received initial approval of its transition plan and has updated the plan to include additional information required for CMS to grant final approval.
This version of the STP includes new information about site-specific assessments, ongoing monitoring and oversight, non-disability specific setting options, communications with beneficiaries regarding provider choice, and notification of provider non-compliance.
HHSC will submit a final Statewide Transition Plan (STP) to the Centers for Medicare and Medicaid Services (CMS). The STP is posted for public comment. All states must obtain final approval of their STP from CMS to comply with the federal Home and Community-Based Services Settings (HCBS) Rule. The STP describes HHSC’s activities and planned initiatives for meeting the requirements of the HCBS Settings Rule.
HHSC invites members of the public, including HCBS recipients and their families, providers and other stakeholders, to submit comments on the STP. Comments will be accepted until 11:59 pm on Feb. 13, 2023.
Access the STP and instructions for submitting public comments here.
Written comments, requests to review comments or both may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or email.
Email: Medicaid_HCBS@hhs.texas.gov
Fax:
Attention: Rachel Neely, Office of Policy at 512-438-5835
U.S. Mail:
Texas Health and Human Services Commission
Attention: Rachel Neely, Office of Policy
John H. Winters Complex
701 W 51st Street
Mail Code H-600
Austin, TX 78751
Overnight mail, special delivery mail, or hand delivery:
Texas Health and Human Services Commission
Attention: Rachel Neely, Office of Policy
John H. Winters Complex
701 W 51st Street
Mail Code H-600
Austin, TX 78751
Phone number for package delivery: 512-438-4297
When Will HCS New Rules and Status of Statewide Transition Plan (STP) Be Adopted?
January 16th, 2023
Adoption Date of HCS Rules and Status of Statewide Transition Plan (STP):
gave HHSC preliminary approval of its STP on 12/21/2022. The STP will be posted for public comment this Friday (Jan. 20th, 2023).
It is unclear when the HCS rules will be adopted.
See graph of draft rules below (pages 12-17 for HCS). Includes CLASS, TxHML, MDCP, and DMDB programs as well.
Appendix A: Home and Community-Based Services (HCBS) Settings Statewide Transition Plan
HCS/TxHML: /TMHP Recoupment, Due To Overpayment
January 15th, 2023
TMHP Recoupment Letters
December 12th, 2022
Avoiding HCS and TxHmL Overpayment of Services
Effective Jan. 2, 2023, Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.
On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount.
On-Site Assessments of HCS Group Homes & Certain HH Settings From CMS
Help With The New Residential Agreements
-An individual’s bedroom door is lockable by the individual, with only appropriate staff having keys to doors.
– An individual has access to food at any time.
Initial Critical Incident Management Services (CIMS) User Account Email
Have You Signed Up For CIMS (Critical Incident Management System)Yet?
Initial CIMS User Account Email
On Monday, Aug. 29, FEI Systems sent another mass email to Critical Incident Management System (CIMS) users who have not logged into CIMS. It will provide your user ID and temporary password. The temporary password in the email will expire after seven days.
This applies to:
- Community Living Assistance and Support Services providers and case management agencies
- Deaf Blind with Multiple Disabilities providers
- Home and Community-based Services providers
- Texas Home Living providers
- Local intellectual and developmental disability authorities
Please do not delay logging into your organization’s CIMS account. The account creation email will come from FEI Systems.
Providers are required to begin entering critical incidents into CIMS by Nov. 1. HHSC strongly encourages providers to become familiar with the system as soon as possible.
AAIDD Texas Chapter: Link To Follow Bills During The Texas 88th Legislative Session
January 12th, 2022
From our good friends at the Texas Chapter of AAIDD, some important info about the Texas 88th Legislative Session
Dion White, Center for Life Resources
AAIDD Texas Chapter Board Member
“Texas is home to more than 500,000 adults and children with intellectual and developmental disabilities (IDD). This legislative session will be very important to address specific changes happening within the IDD systems of care across the State.
Our system of care specific to IDD is currently undergoing changes in its service delivery system. One aspect of this change deals with a transition of IDD long term services and supports going from a traditional Medicaid model to a managed care model. Currently there are plans to pilot test this transition starting in September 2023. This is major change because it may impact the monitoring role of targeted case management. Through targeted case management, services are monitored to insure continuity over time. Currently the IDD local authorities are providing the TCM service.
As Texas continues to grow there is a concern if the entire system of care across the State will grow to meet the increased need of services. Many providers are also dealing with staffing shortages across the State which is making the situation much more difficult. There is a possibility this will be addressed either directly or indirectly during this session.
During this session there will be a-lot of discussion on addressing the IDD population in regard to the new programs starting such as Individualized Skills and Socialization services. The session started on January 10 and will end on May 29th. I encourage all stakeholders to follow legislation specific to IDD services and supports and contact your designated legislator with any concerns you may have. “
A good resource to follow bills online can be found at this link, https://capitol.texas.gov.
Employment Assistance & Supported Employment Training Options From HHSC
Employment Assistance & Supported Employment Training Options From HHSC
January 12th, 2022
“HHSC is pleased to announce the delivery of in-person Employment First / Employment Services training for the first time since 2019. This free one-day training opportunity has proven to be a very valuable opportunity to various levels of staff involved in the support of individuals who set the goal of competitive and integrated employment in the community. Various staff from the Local Authority, along with private providers in the area, as well as stakeholder groups will benefit from this training.
With the very high turnover rates the last several years, this training provides the opportunity to garner a basic understanding of Employment First, Employment Services, Benefits and Work Incentives, Job Coaching, Employment Readiness Skills, and Employer Relationships. Service Coordinators will benefit tremendously from this training as they serve as the first line in service planning. Additionally, a myriad of staff such as social workers, employment support staff, direct service staff, case managers, Qualified Intellectual Disability Professionals (QIDP), management staff and many others have found this training valuable. In short, anyone who has a role in supporting an individual directly or indirectly will benefit from the training.
This training will be offered at numerous locations in the state from February thru August 2023. We are pleased to advise that the first two events will be in Houston on February 7th and 8th. Each day will cover the same training, thus only one day should be chosen when registering.
Training will be held at the Harris Center 9401 Southwest Freeway, Houston, Texas 77074 in Conference Room 104, 9am to 4pm. Each event will have a max attendance limit of 70 people. Thus, moving quickly to register will be important. Please help us in getting the word out to your staff as well as sharing with others outside of your organization who can benefit. Registration is easy. Registrants can use one of the two links below based on the best date for the registrant.”
Thank you and we look forward to seeing everyone on February 7th or February 8th!
August 1st, 2021
Live HHSC Training Workshop!
HHSC is announcing a free, one-day Employment First / Employment Services Training event to be offered in six cities from September 2021 thru December 2021. Employment promotes a more independent living setting and creates independence for a person in many ways. This training is another tool to increase the Employment First focus and provide better tools for providers to improve hands-on skills and increase job opportunities for people with intellectual and developmental disabilities.
Training includes:
· Overview of Texas Employment First Policy
· Employment services in Medicaid waivers
· Basic facts on Social Security Administration disability benefits
· Basic facts on developing an employment profile and vocational assessment
· Building connections and working with families
· Development of soft skills and job-readiness skills
· Basic overview of applications and tablets for use as job coaches
· Building and maintaining strong employer relationships
The training is specifically designed for any staff member who has a role in supporting people who set employment goals or people with direct, hands-on roles such as service coordinators, employment specialists, direct care staff, day habilitation staff, job coaches, supervisors and others who support individuals as they pursue competitive and integrated employment.
Registration Links for each event as follows:
*September 8, 2021 – Lubbock – MGM Elegante (801 Avenue Q, Lubbock, TX 79401)
*September 29, 2021 – Austin – Norris Conference Center (2525 W Anderson Ln #365, Austin, TX 78757)
*October 13, 2021 – McAllen – Cambria Hotel McAllen Convention Center (701 South Ware Road, McAllen, TX, 78501)
*November 4, 2021 – San Antonio – Norris Conference Center (618 Northwest Loop 410 STE 207, San Antonio, TX 78216)
*November 17, 2021 – Corpus Christi – Region 2 Education Center (209 N Water St, Corpus Christi, TX 78401)
*December 1, 2021 – El Paso – Region 19 Education Center, (6611 Boeing Dr., El Paso, TX 79925)
Each event is limited to a maximum of 45 registrants. HHSC highly encourages everyone to register early to make certain a space is reserved. HHSC will also offer a waiting list after they reach the maximum capacity for any event, which will be identified to anyone attempting to register once a given event is full. Those on the waiting list will be contacted in the order received if they are notified of a cancellation.
June 28th, 2021
There are two Home and Community-based Services and Texas Home Living trainings in this series:
The web-based trainings cover employment services provided through HCS and TxHmL, information about the payer of first resort for employment assistance, and the basics of providing these services. They are designed to enhance staff knowledge about providing quality employment services to people enrolled in the waivers.
Each training has a corresponding quiz.
The Direct Service Workers web-based training provides information about employment services and how direct service workers can support people achieve their employment goals. The training covers federal and state initiatives related to employment for people with disabilities and touches on issues related to people who work and receive SSI or SSDI benefits. The training has a corresponding quiz.
Public Health Emergency (PHE) Renewed
January 11th, 2023
RENEWAL OF DETERMINATION THAT A PUBLIC HEALTH EMERGENCY EXISTS
“As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective January 11, 2023, the January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021, July 19, 2021, October 15, 2021, January 14, 2022, April 12, 2022, July 15, 2022, and October 13, 2022, that a public health emergency exists and has existed since January 27, 2020, nationwide.”
From the HHSC ASPR website page, this is the alert concerning continuing PHE. At this time we have no further information on how long this will be ongoing.
ISS Rates
January 11th, 2023
Revised Information Letter (IL) 2023-01 related to ISS Payment Rates (replaces IL 2022-56):
HHSC has published Revised Information Letter (IL) 2023-01, which replaces 2022-56 related to payment rates for Individualized Skills and Socialization Services, effective January 1, 2023.
HHSC has also approved payment rates for the Individualized Skills and Socialization in the Deaf Blind with Multiple Disabilities waiver (DBMD), Home and Community-based Services waiver (HCS), and Texas Home Living waiver (TxHmL) programs, effective January 1, 2023.
- The revised Individualized Skills and Socialization payment rates for these programs can be accessed on the Provider Finance Department Long-term Services & Supports webpage.
- The Long-term care HHSC Bill code Crosswalks which is used to match the Texas Long-term Care (LTC) Local Codes (i.e., bill codes) to the National Standard Procedure Codes (e.g., procedure, item, revenue codes) and claim payment for services is available on the HHSC Long-term Care Bill Code Crosswalk page.
Contact PFD-LTSS@hhs.texas.gov or (737) 867-7817 if you have questions.
December 06, 2022
Last Friday HHSC posted the ISS rates which may be viewed at the link below.
- The on and off-site ISS rates are effective January 1, 2023. It appears to be unlikely any of the licenses for ISS will be approved by that time.
- The current in and out-of home DH rates will remain effective through February 28, 2023.
- ACRE will not be available for the ISS service.
- This is because the current DH rate is a daily rate; the ISS rate is an hourly rate.
- Restructuring this component of ACRE will necessitate additional funds which HHSC will be requesting from the 88th Texas Legislature. Unfortunately, once received access to funds will not be available until September 1, 2023 and which providers choosing to participate in ACRE can request during the July, 2023 enrollment period.
- Though the ISS rules have yet to be adopted (hopefully by no later than December 16th), the proposed rules allow persons with a medical or behavioral justification to receive in-home ISS.
- proposed rules also state that if requested, a person who is 55 or older may also receive in-home ISS.
- The provider of the in-home ISS service does not need to be a licensed ISS provider.
- Note: As proposed, the rules do not address whether persons with the aforementioned justification or request can also participate in community activities and bill for off-site ISS. Though assumed this will not be permitted, we are still waiting for a response.
- The off-site rates allow for two levels of enhanced staffing. Though the proposed rules did not call for two levels of enhanced staffing, the adopted rules will.
- The adopted rules will also change the ratios at least for the ‘LON 1 and LON 5 without enhanced staffing’ category.
September 27th, 2022
Please see the newly proposed ISS (Individualized Skills & Socialization) rates. The proposed rates would be effective January 1st, 2023, if accepted, at the following link: https://pfd.hhs.texas.gov/sites/rad/files/documents/2023/01-01-2023-pmnt-rates-individualized-skills-socialization-%20srvcs.pdf
The recording can be accessed on-demand after the hearing at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings.
Trainings Initiatives: From HHSC
January 10th, 2023
Below are just some of the trainings offered by HHSC on their “Trainings Initiative” page. Some live and some via webinar.
For more information, please go to: https://www.hhs.texas.gov/providers/provider-training/training-initiatives
SSI/SSDI Benefits Overview
The SSI/SSDI Benefits Overview web-based training provides a basic foundation for understanding Supplemental Security Income and Supplemental Security Disability Insurance and provides contact information for people who can help you further understand these programs. The training has a corresponding quiz.
Employment First
The Employment First web-based training covers Texas’ new Employment First policy. The training has a corresponding quiz.
Visit the HHS Employment First website.
HCS and TxHmL
There are two Home and Community-based Services and Texas Home Living trainings in this series:
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.
Direct Service Workers
The Direct Service Workers web-based training provides information about employment services and how direct service workers can support people achieve their employment goals. The training covers federal and state initiatives related to employment for people with disabilities and touches on issues related to people who work and receive SSI or SSDI benefits. The training has a corresponding quiz.
STATUS OF HCS RATES!
Status of HCS Rates as of Jan. 1st, 2023 (includes new ISS rates)
HCS Rates Jan. 1st, 2023 including ISS services
Status of HCS Rates as of June 3rd 2022
Provider Rate Updates for HCS and TxHmL Providers
In early May, HHSC identified missing or incorrect rate keys for some Home and Community-based Services and Texas Home Living providers.
On May 11–12, HHSC completed updates to rate keys for these HCS and TxHmL providers based on rates published on the Provider Finance website.
After confirming rates with Provider Finance and paid claims on the R&S Report, contact the TMHP LTC Help Desk at 800-626-4117, Option 1, then Option 7, if you have additional questions.
https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2022/2022-hcs-awards.pdf
Status of HCS Rates as of January 17th, 2022
HCS and TxHmL Day Habilitation Rates, Respite Rates and Other Concerns
- The Public Health Emergency (PHE) was renewed until April 16, 2022, and
- Clarification: The HCS & TxHmL rates posted on HHSC’s webpage listed as Effective March 1, 2022 to Current. are a bit confusing
Please contact the Rate Analysis Department’s Customer Information Center at (512) 424-6637 or by email at RAD-LTSS@hhsc.state.tx.us should you have any questions regarding the information in this document.
Free Provider Resource Webinar Series
Free Webinars!!
January 2023 Webinars
Core-VA Solutions “Virtual Healthcare Assistants For LTC Programs”
Virtual Healthcare Assistants Services and Training for Long-Term Care Programs, including HCS, TxHmL, and ICF
Free Webinar Series Hosted By: Twogether Consulting (1/10/22 from noon-1pm)
Pre-Registration is required, click on the “Registration” button below to attend this free webinar and complete pre-survey questions!!
REGISTRATION
or Visit our website: www.twogetherconsulting.com and click on the Free Webinar calendar
Twogether Consulting is happy to have Brittney Russo-COO (Chief Operations Officer) from Core-VA Solutions to discuss her company’s “virtual assistant” services.
Core-VA Solutions provides virtual assistance for any type of long-term healthcare setting, whether it be for a small medical office or therapy office or HCS provider. All of our virtual assistants have a degree in nursing and/or health-related fields.
Core-VA is able to serve clients all over Texas and beyond. Some of the clients these virtual assistants work with are those in HCS, TxHmL, and also other IDD programs. This includes assisting with EVV and TMHP billing. Brittney’s team is able to provide appropriate training to her staff to cater to some of your specific needs, including persons with experience in the HCS/TxHmL programs providing some of that training and the IT solutions which they can learn to use using IT fundamentals here to learn for this. They have “virtual assistants” versed in the use of quite a few electronic health records software such as Taskmaster Pro, Focus, and other EHR and billing software. This is a wonderful resource for HCS/TxHmL providers for sure! This is especially true for some of you, who are brand-new HCS/TxHmL providers. Core-VA serves many different clients in other lines of Long-Term Health Services, but it is so nice to have help from a virtual assistant who understands the world of HCS/TxHmL!
-Core-VA team Solutions is part of our free webinar series for the month of January 2023! Click on their postcard below for more information. Services are available at $10/hr and no contracts.
core va post card
“Core-VA Solutions aims to positively change how your long-term healthcare facility operates with our virtual assistants with degrees in nursing and/or health-related fields. We understand that you may currently waste precious time and money completing tedious tasks such as medical reception, appointment scheduling, insurance authorization, receiving and submitting medical information, and so much more. Instead of hiring expensive employees to complete these much-needed tasks, hire our affordable virtual assistants instead, as we can provide you with the same level of service, at a fraction of the price. All you have to do is let us know how we can help, and our team will find the perfect assistant match for your facility!”
“Support & Empowerment Program For Persons With IDD & Their Caregivers”
Twogether Consulting is happy to have Diana Chavarria from AACOG discuss an amazing program offered via a grant from TCDD (Texas Council For Developmental Disabilities). This is a wonderful resource for IDD providers, Caregivers of persons with IDD and persons with IDD. Dianne is part of our free webinar series for the month of January 2023!
Free Webinar Series Hosted By: Twogether Consulting (1/17/22 from noon-1pm)
Pre-Registration is required, click on the “Registration” button below to attend this free webinar and complete pre-survey questions!!
REGISTRATION
or Visit our website: www.twogetherconsulting.com and click on the Free Webinar calendar
The Program Provides Support & Empowerment For Individuals and Their Caregivers Concerning The Following:
-General Health and Aging
-Aging With Specific Syndromes (i.e. Down Syndrome)
-Nutrition & Physical Fitness
-Financial Wellness
-Benefits and Employment
-Planning For The Future
-Mental Wellness
-Coping With A Diagnosis
-Crisis Management
Some Of Our Previously Recorded Free Webinars of Interest
Here is a link to a short, introductory video about the HRST: https://hrstonline.com/video/index.php?id=410335893
Topic: Health Risk Screening Tool
HRST (Health Risk Screening Tool) is an assessment tool that can identify & detect health risks in vulnerable populations. This tool and other services offered by HRS are based on person-centered practices. Here is a little more information about HRS from their website. The Health Risk Screening Tool (HRST) identifies and tracks health risks in vulnerable populations, making it possible to design a plan tailored to meet the unique health and safety needs of each individual in the least restrictive setting. The instrument can objectively justify resources allocated both financially and in service intensity. Used by Case Managers, supervisors, and direct support professionals. HRS also helps the provider to comply with CMS Rules and assist with Person-Centered planning and continuity of care. It is field-tested, reliable, and user-friendly
“Health Risk Screening, Inc.’s roots began in 1992. Along with training courses, webinars, and materials, HRS is the sole developer, producer, and distributor of the web-based Health Risk Screening Tool (HRST). The HRST is the most widely used and validated health risk screening instrument for people with intellectual and developmental disabilities.
HRS was established on the principles of person-centered practices. Our founder, Karen Green McGowan was a pioneer in the early formative days of the person-centered movement.. Our focus is on developing tools and training for the person-centered support of vulnerable populations. Through the education of government agencies and service providers, we have helped improve people’s lives. Along with training courses, webinars and materials, HRS is the sole developer and distributor of the web-based Health Risk Screening Tool (HRST). The HRST is the most widely used and validated health risk screening instrument for people with disabilities.”
For more information, please contact Hillary Gaytan at: Phone: 727.754.9539 Email: hilary@hrstonline.com
You can also go to their website: www.hrstonline.com
Check out this great page they have devoted to COVID-19 Resources: https://hrstonline.com/covid-19-resources/
Guest presenter:
Patrick Lane (PCT Mentor & Trainer)
From: HRS
Date: Thursday -November 12th, 2020 (Session ended)
Time: 11am-12pm (Central Time)
Cost: Free!!!
Where: See recorded link below:
https://attendee.gotowebinar.com/recording/1049673375643527182
Topic: Person-Centered Services
Patrick will be talking about some of the Person-Centered Services offered at HRS including software that helps the provider develop Person-Centered Descriptions. These can be used as a resource for making annual plans Person-Centered by using these same person-centered skills practiced in PCT sessions.
“Person-Centered Planning Training is designed to help you approach support from a more holistic angle, with person-centered practices that respect the autonomy of those with intellectual and developmental disabilities while providing them with the highest possible level of care.”
Improve The Quality of Life
- Balancing personal choice with personal responsibility by establishing and maintaining things that are important to the person with things that are important for the person
- Being integrated in one’s community so that the person is known and respected for her or his contributions.
- Being respectfully communicated with as a person, using language consistent with being a typical adult as opposed to using clinical or system language
- Receiving support that is consistent so that new staff and others know and respect the person’s values and choices, as well as how others can help the person.
- Being matches with staff, housemates, or others that the person making life more enjoyable.
You can contact Patrick at: patrick@hrstonline.com For more info about HRS PCT services, please see the following link: https://hrstonline.com/person-centered-services/
Guest presenter:
Steve Cardie
From: Abundant Health
Date: Tuesday -November 17th, 2020 (Session ended)
Time: Noon-12:45 pm (Central Time)
Cost: Free!!!
Where: See link to the recorded session below:
https://attendee.gotowebinar.com/recording/5931551182568587528
Topic: Cellular Blood Pressure Monitoring System (Free To Medicare Patients!)
“Our new Cellular Blood Pressure Monitor System connects automatically to cell towers and transmits your patient’s information directly to your practice. This device makes it simple for seniors who tend to be more technology challenged to utilize Medicare’s RPM program without the difficulty of connecting to cell phones or the internet. No passwords, no Bluetooth, no internet connections required.
The rapid advance of medical device design plus an enormous upgrade in telecommunications makes Remote Patient Monitoring (RPM) suddenly possible for virtually everyone. Anywhere. In November 2018 CMS officially approved three new billing codes for Remote Patient Monitoring (RPM). The telehealth industry experts agree that this is the biggest financial incentive to date in the history of digital medicine.”
Register for the webinar at https://attendee.gotowebinar.com/register/3642654945259750160
Starting Jan. 2023: New HCS& TxHmL Provider Application Process
January 2nd, 2023
Effective January 2023, the open enrollment application process to get a provisional contract to provide Home and Community-based Services (HCS) and Texas Home Living (TxHmL) services will change.
- You must be enrolled as a Texas Medicaid provider through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment System (PEMS) before applying.
2. To apply, you must complete the Provider Applicant Training (PAT). The PAT is now available on the HHS Learning Portal. Do not take the PAT if you aren’t applying for an HCS and TxHmL waiver contract.
- You must get a score of 85% or higher to pass the exam. Lower scores will not be accepted.
- After completing the PAT, you can apply using Form 5873 Waiver and Community-based Programs and Services. Your PAT exam certificate must be included with your application packet. Do not apply without a PAT exam certificate showing your passing score.
PAT FAQ’s. Please read before taking the PAT!
You must pass this test by 85% and if you fail the 1st x will have to wait 6 months to retake it!
Mail Your Application to the Waiver Program Enrollment Team
Send to this address:
HHSC
Contract Administration and Provider Monitoring
Mail Code W-359 P.O. Box 149030
Austin, TX 78714-9030
Applicants can also submit applications by email: IDDWaiverContractEnrollment@hhsc.state.tx.us or fax: 512-206-3916.
More resources can be found on the HHSC website, including guidance on how to apply and manage your contracts. If you have any questions about the application process, please email us.
Expedited PPE Delivery for Long-Term Care Providers
January 2nd, 2023
HHSC published an alert on Dec. 21, 2022, informing long-term care providers that expedited delivery is available for a limited time for personal protective equipment through the Texas Division of Emergency Management.
This resource is available to all long-term care providers, including:
- Nursing Facilities
- Assisted Living Facilities
- Intermediate Care Facilities
- Home and Community-based Services
- Home and Community Support Services Agencies, including Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities, and Medically Dependent Children Program
- Texas Home Living
- Prescribed Pediatric Extended Care Centers
- Hospice
- Day Activity Health Services
Long-term care providers who have a current need for these specific resources can submit requests by visiting star.tdem.texas.gov and selecting the “Expedited PPE” button. The generic passcode for the inventory listed above is: 112518.
Items are available on a first-come, first-served basis. This system is only to be used on a one-time basis for expedited PPE only. If a provider needs these resources, please include the amount needed in your request.
HCS & ICF Emergency & Disaster Preparation Updates
January 1st, 2023
LTC Winter and Extreme Freezing Weather Preparedness
HHSC encourages long-term care facilities and agencies to review and update emergency plans for freezing temperatures and snow. Emergency plans for extreme weather should include the provider’s plan to address:
- Power loss
- Water and food needs
- Communication to families and staff
- Staffing shortages
- Sheltering in place and evacuation as applicable
Providers must follow emergency preparedness rules and their own internal emergency preparedness policies and procedures.
Facilities with generators should perform any maintenance or needed testing while the weather is mild. This will ensure the equipment functions in case of extreme cold or power loss.
It is important to review building integrity and identify any areas that may need repair, reinforcement or weatherproofing. Multi-story buildings should review any other needed measures should evacuation be required and have a plan in place for how to move residents around or out of the building if there is a loss of power.
Preparing for disaster is the most important step in protecting our most fragile Texans and reducing the risk for loss of life.
May 26th, 2022
Guidance related to Emergency Preparedness- Exercise Exemption based on A Facility’s Activation of their Emergency Plan *** Revised to provide additional guidance and clarifications due to the ongoing COVID-19 public health emergency (PHE) REVISED 05.26.2022 ***
Memorandum Summary
• Emergency Preparedness Training and Testing Program Exemption -CMS regulations for Emergency Preparedness (EP) require facilities to conduct exercises to test the facility’s EP plan to ensure that it works and that staff are trained appropriately about their roles and the facility’s processes. During or after an actual emergency, the regulations allow for a one-year exemption from the requirement that the facility perform testing exercises.
• This worksheet presents guidance for surveyors, as well as providers and suppliers, with assessing a facility’s compliance with the EP requirements, in light of many of the response activities associated with the COVID-19 Public Health Emergency (PHE).
• As the PHE continues, many facilities continue to operate under their respective activated emergency plans. Therefore, CMS is providing additional guidance related to the exercise requirements (full-scale/functional drills and exercises) for inpatient and outpatient providers/suppliers.
• This exemption only applies to the next required full-scale exercise (not the exercise of choice), based on the facility’s 12-month exercise cycle. The cycle is determined by the facility (e.g. calendar, fiscal or another 12-month timeframe).
***All revisions are in red on this letter from CMS, click the link below for the complete document.
September 13th, 2021
Very Important Updates on Emergency & Disaster Preparedness During the Pandemic
Resources Listed Are From CMS & HHSC
See Info For ICF Facilities Below
Life Safety: Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM)
Emergency Preparedness Participant Workbook
Interim Guidance for General Population Disaster Shelters During the COVID-19 Pandemic
Screening Tool For COVID-19 During Pandemic For Arrival At General Population Shelters
Out-of-Hospital Do-Not-Resuscitate Order (From DSHS)
Out-of-Hospital Do-Not-Resuscitate Order
Out-of-Hospital Do-Not-Resuscitate (OOH DNR) order.
Both the English and Spanish versions can be downloaded on the EMS and Trauma Systems website, along with “Frequently Asked Questions About OOH DNR,” also in both languages.
For questions related to OOH DNR orders, email EMSInfo@dshs.texas.gov.
“Moving Forward Together” 2022 Conference for ICF Surveyors and Providers- Dec. 1st, 2022
“Moving Forward Together” 2022 Conference for ICF Surveyors and Providers- Dec. 1st, 2022
Dec. 1 ICF Conference Recordings Available
The “Moving Forward Together” Intermediate Care Facilities Conference session recordings from Dec. 1 are available for viewing. Note that a certificate of completion will be generated upon completion, but no professional CE awards are available.
Listen to the ICF session recordings.
Email questions to LTCR Joint Training.
ICF COVID-19 Response & COVID-19 FAQs Retired By HHSC-Dec. 13th, 2022
December 18th, 2022
HHSC Long-term Care (LTC) Regulation has retired the COVID-19 Response for ICF for Individuals with an Intellectual Disability or Related Conditions Response Plan and the ICF Frequently Asked Questions documents, effective Dec. 13, 2022.
Facilities can obtain guidance along with resources for infection prevention, control measures, and Personal Protective Equipment (PPE) through the Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF) and Infection Control Basics & Personal Protective Equipment for Essential Caregivers (PDF) documents published by HHSC.
These resources can also be found on the ICF Provider Portal page.
Program providers may reach out to LTCR Policy with questions at LTCRPolicy@hhs.texas.gov.
HHSC Complaint and Incident Intake Voicemail Reporting Option Ends on Dec. 31 (ICF/IID)
December 11th, 2022
The provider self-reporting voicemail option will be transitioned out of service on Dec. 31, 2022. Effective Jan. 1, 2023, provider self-reported incidents must be submitted using one of the methods indicated below:
This does not apply to HCS or TxHmL, only ICF and other LTC programs such as ALF’s, SNF’s, DAH’s…
- Online via Tulip
- Email ciicomplaints@hhs.texas.gov
- Call 800-458-9858 (available Monday–Friday, 7 a.m.–7 p.m.)
Please ensure that all initial self-reported incidents include the relevant information detailed in Provider Letter 18-20.
HHSC Retires LTCR Provider Investigations Policy Mailbox
December 11th, 2022
The Health and Human Services Commission (HHSC) created the Regulatory Services Division in 2017 as regulatory functions consolidated from the Department of Family and Protective Services, the Department of Aging and Disability Services and the Department of State Health Services. As part of this consolidation effort, effective Jan. 30, 2023, HHSC will retire the Provider Investigation policy mailbox at PIPolicy@hhs.texas.gov.
For questions about investigations, please use the Long-term Care Regulation Policy and Rules mailbox at LTCRPolicy@hhs.texas.gov.
New VPN (HCS/TxHmL) For TMHP Claims
December 10th, 2022
Know that effective December 22, 2022, all HCS/TxHmL providers will need to have migrated to Palo Alto VPN for billing claims!
IMPORTANT: Clarification on HCS/TxHmL IPC Status in “Pending DADS Review”
December 06th, 2022
Please see this alert that was just sent to the 3 IDD associations from HHSC
ISS (Individualized Skills & Socialization) Provider Webinar Recording
Recording of Individualized Skills and Socialization- Provider Licensing Application Process Webinar
December 06, 2022
If you were not able to listen to the November 30th webinar on navigating TULIP/applying for an ISS license, the recording of the webinar and the presentation are now posted. See below for details. Though assumed that persons who listen to the recording will also be able to download a certificate, HHSC has yet to confirm that
Listen to the webinar recording.
Read the Individualized Skills and Socialization webinar (PDF).
Any questions or requests for transcripts may be emailed to LTCR Policy.
Recording of Individualized Skills and Socialization Provider Webinar
HHSC hosted the Individualized Skills and Socialization Provider Webinar on July 19 and Aug. 22 for Home and Community-based Services, Texas Home Living, and Deaf Blind with Multiple Disabilities program providers.
This webinar — offered on Tuesday, July 19, from 2:30–4:30 p.m. and on Monday, Aug. 22, from 2–4 p.m. — provided information on the upcoming new service, individualized skills and socialization. Both webinars will provide the same information, so program providers can register for the time that works best for them.
Below are the links to the recorded sessions from July 19th and 22nd. Please just click, register, and the presentation will begin.
Register now for the July 19 webinar.
Register now for the Aug. 22 webinar.
Handout: Read the Individualized Skills and Socialization Provider Webinar (PDF).
Email HCS Policy and LTCR Policy for questions and to request a transcript of the webinar or ask questions.
Email questions about the webinar to your program policy inbox:
July 19 Individualized Skills and Socialization Provider Webinar Recording Available
A recording of the July 19 Individualized Skills and Socialization Provider Webinar with HHSC Long Term Care Regulation and HHSC Long Term Services and Supports is available for those who could not attend. The webinar recording and slides have been posted to the Individualized Skills and Socialization webpage, the HCS and TxHmL Webinars & FAQs webpage, and the DBMD Provider Training, Webinars and Podcasts webpage.
Read the Individualized Skills and Socialization Provider Webinar (PDF).
Email HCS Policy and LTCR Policy for questions and to request a transcript of the webinar.
Pre-enrollment Site Visit Required for HCS and TxHmL Providers That Enrolled Through PEMS
December 1st, 2022
Home and Community-based Services and Texas Home Living waiver program providers that enrolled through the Texas Medicaid and Healthcare Partnership Provider Enrollment and Management System will be subject to a pre-enrollment site visit from TMHP. Read the full alert.
Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program providers that enrolled through the Texas Medicaid & Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS) will be subject to a pre-enrollment site visit from TMHP.
The pre-enrollment site visit is required for enrollment in Texas Medicaid. The HCS program site visits will be conducted at the locations listed on the enrollment application, including the business office and any locations where clients receive residential assistance services.
A TMHP site visit coordinator will reach out through email or phone to schedule a visit. If the TMHP site visit coordinator is unable to reach the provider, then TMHP will conduct an unannounced site visit.
If providers have questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7)
A few items I want to make you aware of if you are a new HCS/TxHmL Provider Applicant:
- They may want to know what services you intend to use to bill via TMHP.
- i.e. TMHP billing specialist, or billing agency, someone at your agency using only TMHP or also specific outside software to make it easier to monitor and complete your billing (i.e. Millen Pro Billing services and/or software), or via Electronic Health Records for instance that have TMHP and EVV billing capabilities (TaskMaster Pro, TMHP, etc..)
- You do not have to have a group home when they visit before you have a contract. You don’t have clients yet and HCS does not require you to purchase or rent a home prior to receiving your contract. (Adult Mental Health HCBS program does require you have a home)
- You do not have to have a rented business office or “storefront”. You can use your “home office”. But you may need to explain how you intend to see your clients, meet potential families and clients or do staff trainings and still maintain privacy. Perhaps you can ask your local LIDDA’s if they have meeting spaces available to the providers, or you may use virtual office space, hotel conference/meeting rooms, and any staff training for group homes that will happen in the group home for example..
- Make sure if it is a home office, that it really is a delegated space for your office.
- They may want to know how you plan to maintain privacy and security with client records electronically stored, transferred, shared, or disposed of.
- They may request a few policies (security and privacy inquiry form policies and procedures, complaint process, etc..) please contact me if you want a list of the rest or if you want to hire us to provide some of them for you. Twogether Consulting Ph: 512-294-8032
Determination of Intellectual Disability Information Update
December 1st, 2022
Texas Health and Human Services Commission (HHSC) updated the following information regarding the Determination of Intellectual Disability (DID):
- DID Best Practice Guidelines website
- DID Best Practice Guidelines (PDF)
- Become a Certified Authorized Provider to Conduct a DID website
For more information, email the IDD Services Team.
LTC Online Portal Enhancements for HCS and TxHmL Waiver Programs- Starting December 2022
December 1st, 2022
Overview of Upcoming LTC Online Portal Enhancements for HCS and TxHmL Waiver Programs
On December 12, 2022, the Texas Medicaid and Healthcare Partnership will implement several enhancements to the TMHP Long-Term Care Online Portal. After the enhancements are implemented, existing information and training materials will be updated. Read full alert.
-IPC Forms
-Termination Forms
-Pre-Enrollment Forms
-Individual Movement (IMT) Local Authority (LA) Reassignment Forms
-Provider Location Update (PLU) Forms
Other System and Form Enhancements
The Inactivate and Correct this Form buttons on the 8578 Intellectual Disability/Related Condition (ID/RC) Purpose Code (PC) 2 and Initial Enrollment IPC forms will be available only to HHSC staff.
This will decrease the potential for pre-enrollment and enrollment forms to get out of sync, as well as decreasing unnecessary form inactivations.
Account Preparation and Additional Resources
To prepare for these changes, HCS and TxHmL providers and LIDDAs that do not have an LTCOP account need to create an administrator or user account. Providers and LIDDAs can find instructions for creating an account in the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide (QRG).
Additionally, providers and LIDDAs are encouraged to visit the TMHP 1915(c) Waiver Programs web page for recent news, reference materials, education, and bulletins.
For more information, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7).
October 23rd, 2022
LTC Portal Enhancements: Coming Soon!
Beginning in December 2022, several enhancements will be implemented for the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal. The enhancements will improve form submission and portal functionality. Information about these upcoming changes will be available in future articles on the TMHP 1915(c) Waiver Programs web page.
Account Preparation and Additional Resources
To prepare for these changes, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers and local intellectual and developmental disability authorities (LIDDAs) that do not have an LTC Online Portal account need to create an administrator or user account. Providers and LIDDAs can find instructions for creating an account in the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide (QRG), which is available in the TMHP Learning Management System (LMS), and on the TMHP website.
Note: To access the LMS, register for the LMS by clicking the Don’t Have an Account? Sign Up Here button beneath the login field.
(FYI-This includes HCS/TxHmL provider applicants who are going to have their contracts approved soon to begin services. If you haven’t signed up for the LTC Portal yet, please do so!)
Additionally, TMHP encourages providers and LIDDAs to visit the TMHP 1915(c) Waiver Programs web page for recent news, reference materials, education and bulletins.
For more information, contact the TMHP LTC Help Desk at 800-626-4117, option 1, then option 7.
American Rescue Plan Act (ARPA): Provider Retention Payments Regarding HCS/TxHmL Billing Claims from March 2022-August 2022
November 14th, 2022
Don’t forget: HHSC has extended the time for any providers eligible for these ARPA payments to complete the attestation, so that the initial and final reports are not due, until 30 calendar days after the end of the COVID Public Health Emergency (PHE).
July 4th, 2022
American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments
Initial report is now due by August 15, 2022.
The Texas Health and Human Services Commission (HHSC) implements American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention payments.
HHSC is providing funds to agency providers and consumer-directed services employers to support recruitment and retention efforts for direct care staff delivering HCBS services. Payments made under this section can include one-time financial compensation directed toward direct care staff, including lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
Providers who may be eligible to receive funds are:
- 1915 (c) Texas Home Living (TxHmL) Provider Agency
- 1915 (c) Home and Community-Based Services (HCS) Provider Agency
- 1915(i) Home and Community-Based Services – Adult Mental Health (HCBS – AMH) Provider Agency
- 1915 (c) Home and Community-Based Services (HCS) CDS Employer
- 1915 (c) Texas Home Living (TxHmL) CDS Employer
- see the HHSC HCBS website for other types of additional information on ARPA funds.
HHSC is providing time-limited reimbursement increases to strengthen and stabilize the HCBS workforce. Temporary rate increases will be made on eligible HCBS service claims with dates of service between March 1, 2022, and August 31, 2022.
Providers receiving temporary rate increases must complete an attestation and complete an initial report by August 15, 2022.
HHSC will announce the due date for the final report in a follow-up notice. Providers will have at least 30 days to complete the final report.
Providers who fail to complete the required attestation and reporting will be subject to recoupment of HCBS ARPA funds.
Consumer Directed Services (CDS) Employers and Financial Management Services Agencies (FMSAs)
The CDS participant, as the employer of record, may choose to submit the required attestation and reports or work with the Financial Management Services Agency (FMSA) to submit the attestation and reports on the CDS participant’s behalf. FMSAs may also reach out to the CDS participants to offer assistance in submitting the attestation and reports. FMSAs can submit the required information for multiple CDS participants in the FMSA HCBS ARPA Attestation and Initial Report Template. Pursuant to Texas Administrative Code rule 1 TAC 355.207(c)(4), to be eligible for the temporary rate add-on, providers must submit required reports regarding the use of funds and provide data to document vacancy rates in direct care staff and other indicators. If completing the attestation and reports on behalf of a CDS participant, FMSAs should work with the CDS participant to collect all required data. The deadline for the attestation and initial reporting has been extended to August 15, 2022.
Information regarding ARPA HCBS Provider recruitment and retention payments is available on the HHSC Provider Finance website.
June 2nd, 2022
Don’t Forget!
American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments Attestation and Initial Reporting
Initial report is due by July 1, 2022.
The Texas Health and Human Services Commission (HHSC) implements American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention payments.
HHSC is providing funds to agency providers and consumer-directed services employers to support recruitment and retention efforts for direct care staff delivering HCBS services. Payments made under this section can include one-time financial compensation directed toward direct care staff, including lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
HHSC is providing time-limited reimbursement increases to strengthen and stabilize the HCBS workforce. Temporary rate increases will be made on eligible HCBS service claims with dates of service between March 1, 2022, and August 31, 2022.
Providers receiving temporary rate increases must complete an attestation and complete an initial report by July 1, 2022.
HHSC will announce the due date for the final report in a follow-up notice. Providers will have at least 30 days to complete the final report.
Providers who fail to complete the required attestation and reporting will be subject to recoupment of HCBS ARPA funds.
Information regarding ARPA HCBS Provider recruitment and retention payments is available on the HHSC Provider Finance website.
May 19th, 2022
HCS/TxHmL providers:
Please be aware of the following for claims being paid from March 1st, 2022-August 31st, 2022 in TMHP: There are new Procedure/Billing Codes in TMHP that reflect the ARPA short-term funding as retention payments you may be receiving for these claims billed during this time period. If you are seeing new or different codes than you are used to, listed when you pull up “paid” claims, then you are receiving ARPA Retention payments and will be responsible for documenting how these funds were used and reporting this by July of 2022, or you are subject to recoupment from the MCO’s. (Example: M0115, M0116, M0117…)
See rates and new codes listed in link below:
https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:cca5939a-6173-346e-9fc2-3409490a5447
Personally, I was under the assumption that providers would have to request this assistance if they wanted it, meaning they would choose whether they utilized this funding or not. Apparently not necessarily as some providers have noted this is showing up on their payments. From everything I am reading, the provider letters from HHSC do seem to indicate every provider will receive the funding.
Meaning additional (ARPA) monies that the provider is receiving in claim payments for that time period, will need to be accounted for, and reporting on how funds were utilized will need to happen and be sent into HHSC. Some providers are noticing a difference in the regular rates they submitted claims for when they look at their “paid claims”. If the provider uses the ARPA intended, attestation and reporting to HHSC must occur.
If the HCS/TxHmL provider chooses not to utilize the added-on payments to the normal rates, I believe they will need to hold back/save these additional amounts for each claim paid from March to August of 2022, in order to pay them back at a later date. If these ARPA funds are utilized, then the HCS/TxHmL Provider will need to complete a report by July of 2022. I believe, to HHSC by the provider, or they will have to keep it in an account and saved for repayment/recoupment when requested by the MCO’s if I understand correctly. I will keep you posted! Also, please look for the additional FAQ’s to be published on May 23rd, 2022 for hopefully important answers to the TMHP questions and issues many providers have expressed with entering IPCs in particular (especially revisions) entering billing claims, and only getting paid for part of billing claims submitted.
Here Are Just Some Of The FAQ’s HHSC Recently Published May 5th, 2022 (specifically related to this issue I have noted above)
Q: What are the ARPA HCBS Provider Retention Payments?
A: HHSC’s ARPA HCBS spending plan included recruitment and retention payments for providers delivering attendant and direct care HCBS for retention bonuses or other activities. HHSC’s spending plan requires providers to use at least 90 percent of HCBS ARPA funds for one-time financial compensation for their direct care workforce, including, but not limited to, lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
Q: What Services are eligible for Provider Retention Payments?
A: HCBS ARPA temporary rate add-on will be applied to HCBS personal attendant and nursing services as defined in 1 TAC 355.207. A list of eligible services is defined in Section 355.207(b)(1). An updated service list and fee schedule is available on the Provider Finance Homepage.
Q: What identifying information do I need to include with my attestation and required reports?
American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments
The Health and Human Services Commission (HHSC) American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments is part of the HHSC APRA Spending Plan.
The HCBS ARPA Retention Payments will be distributed as a temporary rate add-on to agency providers and consumer-directed services employers to support recruitment and retention efforts for direct care staff delivering HCBS services. Eligible providers can use the temporary add-on to provide one-time financial compensation directed toward direct care staff, including lump-sum bonuses, retention bonuses, and paid time off to receive a COVID-19 vaccination or to isolate after receiving a positive COVID-19 test.
HHSC adopted a new Texas Administrative Code rule 1 TAC 355.207 governing the HCBS ARPA Retention Payments, including the attestation and reporting requirements. Eligible providers who receive the add-ons but fail to complete the required attestation and reporting will be subject to recoupment of the associated payment add-ons.
Click here to submit the required attestation and initial report due July 1, 2022.
HHSC will provide additional information regarding the due date for the Final report at a later date. Providers will have at least 30 days to submit the final report.
- View HCBS ARPA Eligible Services and Rate Add-on Fee Schedule (.pdf)
- View HCS and TxHmL Rate Add-on Fee Schedule for Bill Codes effective after 05-01-2022 (.pdf)
- View Provider Information Letter IL-2022-30 (.pdf)
- View HCBS ARPA Frequently Asked Questions (.pdf)
Please contact the HHSC Provider Finance Department, Long-term Services and Supports Customer Information Team at PFD-LTSS@hhs.texas.gov or (512) 867-7817 if you have questions regarding HCBS ARPA Provider Retention Payments.
TMHP Enhancements Release Dates
November 11th, 2022
TMHP Enhancements
According to HHSC the enhancements (improvements) planned for release this month will most likely be posted later this week or early next week. These posted enhancements will not be effective until Dec. 12, 2022.
HHSC will go over these enhancements in depth at the December 8th, 2022 Migration Webinar
September 23rd, 2022
There are 2 sets of HHSC and TMHP ‘enhancements’ (or ‘fixes’ or ‘improvements’ to the system) to be released in the near future. HHSC has said that the first set of ‘enhancements’ will be released November 4, 2022, and the second set will be released in June of 2023.
Public Health Emergency (PHE) Status
November 11th, 2022
At this time, according to HHSC the PHE is set to end on January 11, 2023. Currently, it is not known whether it will be extended beyond January 11th, 2022. It is possible providers will be notified this week in some alerts if PHE will be extended beyond January 11, 2023.
Why is this important?
*This is important as COVID-19 flexibilities may end and Medicaid status may be lost for those individuals in our waiver and ICF programs where provider has not responded to previous warning letters from CMS that their Medicaid status will not automatically be renewed without reapplying.
THERAP Information and Resources
Previous Webinars Hosted ByTwogether Consulting: Therap during our free resource webinar series below. Just click on the links and register.
October 2022
https://attendee.gotowebinar.com/recording/2347988816141652494
August 2022
https://attendee.gotowebinar.com/recording/1388286687336697103
If you need assistance with your current Therap services or with information on getting these services, please contact:
Calvin Christensen(Business Development Consultant at Therap Services, LLC)
Here is his LinkedIn page
https://calendly.com/calvin-christensen/system-demonstration?back=1&month=2022-10
Other Resources
Overview of new pharmacy interface feature with orders, MARS, etc…
Overview of GER Reports (Incidents, Injuries, Med Errors…)
https://help.therapservices.net/app/general-event-reports
https://www.therapservices.net/
For more information on Therap please see link below:
https://www.therapservices.net/products/comprehensive-esolution-for-texas-providers/
Data-Driven:
Person-centered solutions your organization can use to support agency workflows, communication, compliance, organizational outcomes, and revenue management
TaskMaster Pro Information & Resources
October 31st, 2022
Previous Webinars Hosted ByTwogether Consulting: TaskMaster Pro (TMP) during our free resource webinar series below.
Just click on the links and register.
October 20th, 2022
https://attendee.gotowebinar.com/recording/1488497278022599682
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Monthly Webinars on Migration of CARE to TMHP
January 15th, 2023
Jan. 11th TMHP LTC Migration Webinar
- R & S Video Series for LTC Providers & FMSAs: There are 3 videos related to this topic:.
October 23rd, 2022
Oct. 5 TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar Recording Available
A recording of the Oct. 5 TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar is available for those who could not attend.
The webinar recording and slides have been posted to the HCS and TxHmL Webinars & FAQs webpage.
For questions, email TxHmL Policy.
October 13th, 2022
Monthly Meetings/Webinars On Migration To TMHP LTC Portal for HCS/TxHmL/FMSA’s
Medicaid and CHIP Services (MCS) will begin hosting monthly meetings for Providers and Financial Management Services Agencies (FMSAs) who use the Long-Term Care (LTC) Online Portal for the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver programs, beginning in October will be held to discuss trending issues, share solutions established to address barriers providers and LIDDAs are experiencing, answer questions, etc.
Texas Medicaid & Healthcare Partnership (TMHP) and Health and Human Services Commission (HHSC) staff from the following departments will be available to provide information and answer questions:
- Program Eligibility and Support (PES).
- Utilization Review (UR).
- Provider Claims Services (PCS).
- Contract Administration & Provider Monitoring (CAPM).
- Local Procedure Development and Support (LPDS).
Save the Dates
The webinars will be held on the following dates. We encourage Providers and FMSAs to invite staff who use the LTC Online Portal for HCS and TxHmL programs.
- October 2022: Wednesday, Oct. 5, 1–2 p.m. Register for the webinar.
- Here is a copy of the handout from October 5th, 2022, if you missed the webinar. The recording of that session will be posted in the near future.
- November 2022: Wednesday, Nov. 9, 10–11 a.m. Register for the webinar.
- December 2022: Thursday, Dec. 8, 1–2 p.m. Register for the webinar.
Standing Meeting Agenda
- Trending issues – discuss trending issues and solutions to increase successful processing of forms.
- Updates on LTC Online Portal for HCS and TxHmL – provide relevant updates.
- Questions and Answers – HCS and TxHmL Providers and FMSAs will have the opportunity to ask questions* regarding LTC Online Portal for HCS and TxHmL.
*To comply with HIPAA requirements, questions that include any identifying information for a specific individual will not be allowed during the monthly meetings.
Email Questions to TxHmL Policy.
Don’t Forget To Get Ready For Flu Season!
October 17th, 2022
From HHSC:
LTC Providers Encouraged to Get Ready for Flu Season
CDC recommends everyone be vaccinated against the flu by the end of October to avoid peak flu season. Long-term care providers should review their program requirements for guidance related to vaccination requirements and infection control.
Some of the CDC’s recommendations for vaccinating patients in congregate healthcare settings are:
- The CDC recommends that LTC facilities offer the flu vaccine to all residents and healthcare staff throughout the flu season.
- Residents with close contact to someone with COVID-19 and asymptomatic and pre-symptomatic residents in isolation can be vaccinated.
- For residents with suspected or confirmed COVID-19 who are symptomatic, healthcare personnel can postpone their vaccine until meeting the criteria for discontinuing isolation. The person should not be considered moderately or severely ill and should have fully recovered from acute illness as recommended by the CDC.
Administer COVID-19 vaccines without regard to the timing of other vaccines. This includes administering the COVID-19 and flu vaccines at the same time. Access the CDC’s COVID-19 vaccine and coadministration with other vaccines for more information.
Adhere to standard precautions. They are the foundation for preventing the transmission of infectious agents in all healthcare settings and help prevent the flu.
Implement droplet precautions for those with suspected or confirmed flu. Do this for seven days after illness onset or until 24 hours after the fever and respiratory symptoms resolve, whichever is longer, while the person is in a long-term care facility.
Per TAC Title 25, Part 1, Chapter 97, report all outbreaks to the local health department, regardless of the provider type. Contact information for your local health department is on the DSHS website.
For more information, view:
Texas Culture Change Coalition Conference-“A Day Focused On Person-Centered Senior Care” Nov. 3rd, 2022-Austin, Tx
October 16th, 2022
Register for Texas Culture Change Coalition Conference
The Texas Culture Change Coalition will host their in-person fall 2022 conference, “Texans Coming Together for Residents, for Staff, for All!”
This year’s theme is “A Day Focused on Person-Centered Senior Care.”
Nov. 3
8 a.m.–5 p.m.
Commons Conference Center (J.J. Pickle Research Campus)
10100 Burnet Road, Bldg. 137
Austin, TX 78758
Continuing education credit for multiple disciplines will be provided for this event.
For more information, visit the Texas Culture Change Coalition website.
HCS Provider Response & Visitation Emergency Rules: COVID-19-Update 2022
October 17th, 2022
HHSC HCS Program Provider Response to COVID-19 Emergency Rule Expired Oct. 14
The emergency rule for Home and Community-based Services waiver program providers that contain the HCS Program Provider Response to COVID-19 Emergency Rule expired Oct. 14.
The following rule expired Oct. 14:
- 40 Texas Administrative Code Section 9.198 – Program Provider Response to COVID-19 Emergency Rule
HCS program providers must continue to comply with visitation requirements for essential caregivers and clergy in a disaster located in TAC Chapter 570 as well as all other applicable rules and certification principles.
See Section 9.198 below:
40 Tex. Admin. Code § 9.198
July 11th, 2022
Provider Letter 2022-13, Version 2: Petition To Suspend Essential Caregiver Visits
HHSC issues PL 2022-13, Version 2 with additional information regarding how a facility or program provider may petition HHSC to suspend in-person essential caregiver visits.
Read PL 2022-13, Version 2 here.
“A facility or program provider may petition HHSC to suspend in-person
essential caregiver visits for no more than 7 consecutive calendar days
if in-person visitation poses a serious community health risk. To
petition for a suspension of in-person essential caregiver visits, a
facility or program provider must submit a request to their Regional
Director (RD) by email. The contact information for each Regional
Director is available on the Long-term Care Regulatory Regional
Contact Numbers website. A facility or program provider may request
an extension from HHSC to suspend in-person essential caregiver
visitation beyond the original request, but HHSC may not approve an
extension that exceeds 7 days. HHSC may deny a petition to suspend
in-person essential caregiver visits if HHSC determines that in-person
essential caregiver visits does not pose a serious community health
risk.”
July 5th, 2022
Updated HCS/TxHmL COVID-19 Response Plan, FAQ Documents- June 24th
HHSC Long-term Care Regulation updated the COVID-19 Response Plan and FAQ documents on June 24. The updates remove instructions on how to ask for emergency staffing from HHSC.
Read the revised COVID-19 Response for HCS Providers (PDF).
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
May 7th, 2022
Updated HCS/TxHmL COVID-19 Response Plan, FAQ Documents-May 5th
HHSC Long-term Care Regulation updated the COVID-19 Response Plan and FAQ documents on May 5. The updates remove instructions on how to ask for emergency staffing from HHSC.
Read the revised COVID-19 Response for HCS Providers (PDF).
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
February 20th, 2022
Updated HCS COVID-19 Response Plan and FAQ Documents – Feb. 18
HHSC Long-term Care Regulation updated the HCS COVID-19 Response Plan and FAQ documents.
Read the revised COVID-19 Response for HCS Providers (PDF).
Read the revised Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF).
Updated COVID-19 Provider Response and Visitation Emergency Rules for HCS Providers – Feb. 17
HHSC Long-Term Care Regulation published revised HCS COVID-19 Provider Response to COVID-19 and Expansion of Reopening Visitation Rules (PDF). HCS providers must now screen individuals and staff per HHSC guidance.
HHSC Long-Term Care Regulation published revised COVID-19 Expansion of Reopening Visitation Emergency Rules. They are for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions program providers. HHSC removed the following language:
“If an executive order or other direction is issued by the Governor of Texas, the President of the United States, or another applicable authority, that is more restrictive than this rule or any minimum standard relating to a facility, the facility must comply with the executive order or other direction.”
The rules became effective Feb. 17, 2022.
January 7th, 2022
HCS and TxHmL COVID-19 Response Plan Updated – Jan. 7th, 2022
HHSC has revised the HCS and TxHmL COVID-19 Response Plan in response to the most recent CDC guidance.
September 23rd, 2022
HCS COVID-19 Mitigation & Expansion of Visitation Rules:
Revision Response Plan
COVID-19 Response Plan (PDF) in response to the revised HCS and TxHmL COVID-19 Mitigation and Visitation rules
Update: April 17th, 2021
HHSC Publishes HCS Expansion of Reopening Visitation Rules
Original Published: March 25th, 2021
3.0 HCS Expansion of Reopening Visitation Rule
To read more, please click on the link below:
https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:a7d8cd88-7334-4f8b-89b3-5876693ceb1a
*** Please Don’t Forget To Update Your Policies & Procedures Based On The Changes. Feel Free To Contact Twogether Consulting For Assistance! Info@twogetherconsulting.com
The new expanded visitation rules do not apply to host home/companion care providers unless otherwise specified in rule. See the HCS Provider Response to COVID-19 Expansion of Reopening Visitation Rule at 40 TAC 9.199 for the complete list of requirements.
The new visitation rules provide flexibility for HCS program providers that have offered a complete series of a one- or two-dose COVID-19 vaccine to individuals and staff and documented each individual’s choice to vaccinate or not vaccinate, including:
• Essential caregiver and end-of-life visits are permitted for all individuals with any COVID-19 status.
• The definition of an end-of-life visit has been expanded to include for more flexibility on when an individual is considered at end-of-life so an individual’s family and loved ones have more opportunity to visit.
• Indoor visitation no longer requires the use of a plexiglass barrier.
• A program provider may not require a visitor to provide documentation of a COVID-19 negative test or COVID-19 vaccination status as a condition of visitation or to enter the residence.
• Provider staff no longer have to escort or monitor visitors once they have passed screening and entered the facility.
• Program providers are no longer required to submit an attestation form to facilitate visitation.
• Visitation is required and a program provider must facilitate indoor and outdoor visitation without a reasonable clinical or safety cause.
The provider can continue to document the individual’s choice whether to receive a COVID-19 vaccine or not to receive a COVID-19 vaccine as applicable for new admissions or individuals who return to the residence from leave.
Visitor Limitations: (Indoor and Outdoor)
3.3 Indoor and Outdoor Visits
HCS program providers that have offered a complete series of a one- or two-dose COVID-19 vaccine to individuals and staff and documented each individual’s choice to vaccinate or not vaccinate, must allow indoor and outdoor visitation.
Program providers do not have to complete an attestation form or use plexiglass barriers to facilitate indoor or outdoor visitation. The program provider accommodates visitation based on the space available as necessary to ensure physical distancing between visitation groups and safe infection prevention and control measures.
3.3.1 Indoor Visitation
• The program provider must allow indoor visits for individuals who are COVID-19 negative, if there are no confirmed COVID-19
infections or suspected COVID-19 cases for at least 14 consecutive days among staff. • The provider must reasonably limit the number of simultaneous visitors per individual and limit the total number of visitors in the residence simultaneously, based on the size of the building and physical space and staffing capabilities.
• Plexiglass barriers are no longer required.
3.3.2 Outdoor Visitation
The program provider must allow outdoor visits for individuals who are COVID-19 negative and must:
• ensure a comfortable, accessible, and safe outdoor visiting area for outdoor visits, considering outside air temperatures and ventilation; and
• limit the duration, frequency, size, and number of visits as necessary to ensure physical distancing between visitation groups and safe infection prevention practices.
3.3.3 Limitations for Visitation
The following limitations apply to all visitation types, including essential caregiver visits, end-of-life visits, and indoor and outdoor visitation:
• Visits must be scheduled to allow time for cleaning and sanitization of the visitation area between visits.
• Indoor and outdoor visits are permitted for individuals with COVID-19 negative status only, except essential caregiver and end-of-life visits. Essential caregiver and end-of-life visits are permitted for an individual with any COVID-19 status.
• The visitor and individual they are visiting do not have to physically distance from each other but must distance from other persons in the residence.
• The visitor must wear a face mask or face covering. For individuals who rely on lip reading or facial cues for communication needs, the visitor may use face masks with a clear screen over the mouth.
• The provider must encourage the individual to wear a face mask, if tolerated, throughout the visit.
• When visitors come to the home, staff members no longer need to escort the visitor or monitor the visit, regardless of the visitation type.
• Both the individual and visitor(s), must perform hand hygiene (i.e., use an alcohol-based hand sanitizer or wash hands with soap and water) before the visit. The program provider must make hand hygiene supplies available.
Limited Visitation Designation and Attestation
4.0 Limited Visitation Designation and Attestation Requirements
If an HCS program provider has not offered at least one complete series of a one- or two-dose COVID-19 vaccine to individuals and staff, the program provider may allow limited personal visitation.
4.1 Essential Caregiver Visits
An essential caregiver visit is defined as a personal visit between an individual and a designated essential caregiver, permitted for all individuals with any COVID-19 status, including:
• COVID-19 negative;
• unknown COVID-19 status; or
• COVID-19 positive.
A program provider cannot require an essential caregiver visitor to provide documentation of a negative test result prior to visitation. The following requirements apply to essential caregiver visits:
• There may be up to two permanently designated essential caregivers per individual.
• Only one essential caregiver visitor at a time may visit an individual.
• The visit may occur outdoors, in the individual’s bedroom, or in another area in the home that limits the essential caregiver visitor’s movement through the residence and interaction with other individuals and staff.
• Essential caregiver visitors do not have to maintain physical distancing between themselves and the individual they are visiting but must maintain physical distancing between themselves and all other persons in the residence.
• The individual must wear a face mask or face covering over both the mouth and nose (if tolerated) throughout the visit.
• The program provider must develop and enforce essential caregiver visitation policies and procedures, which include:
o a written agreement that the essential caregiver visitor understands and agrees to follow the applicable policies, procedures, and requirement;
o training each essential caregiver visitor on proper personal protective equipment (PPE) usage and infection control measures, hand hygiene, and cough and sneeze etiquette; and
o a requirement that the essential caregiver visitor must wear a face mask and any other PPE in accordance with CDC guidance and the program provider’s policy while in the residence.
The program provider must:
• inform the essential caregiver visitor of applicable policies, procedures, and requirements;
• approve the essential caregiver visitor’s face mask and any other PPE in accordance with CDC guidance and the program provider’s policy, or provide an approved face mask and other PPE;
• maintain documentation of the essential caregiver visitor’s agreement to follow the applicable policies, procedures, and requirements;
• maintain documentation of the essential caregiver visitor’s training;
• maintain documentation of the identity of each essential caregiver visitor in the individual’s records and verify the identity of the essential caregiver visitor at the time of each visit;
• maintain a record of each essential caregiver visit, including:
o the date and time of the arrival and departure of the essential caregiver visitor;
o the name of the essential caregiver visitor;
o the name of the individual being visited; and
o attestation that the identity of the essential caregiver visitor was verified; and
• prevent visitation by the essential caregiver visitor if the essential caregiver has signs and symptoms of COVID-19, or an active COVID-19 infection.
The program provider can ask the essential caregiver to leave the residence if the essential caregiver visitor fails to comply with the program provider’s policy regarding essential caregiver visits or applicable requirements.
4.2 Limited Visitation without Attestation Form
All HCS residences can allow the following visits without completing the HCS Expanded Visitation Attestation:
• Visits by persons with legal authority to enter
• Visits by providers of essential services
• Visits by essential caregivers
• End-of-life visits
• Closed window visits
The visitors listed above must be screened prior to entry to the residence and cannot be allowed inside the residence if they fail screening.
Definitions and Attestation Form Update: https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:a7d8cd88-7334-4f8b-89b3-5876693ceb1a
HHSC Publishes HCS Expanded Visitor Attestation Rules & Guidance Letter
September 25th, 2020
HHSC Visitor Expansion Rule. See the following rules in PDF updated on 9/25/20. https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/long-term-care/hcs/hcs-covid-19-updated-emergency-rules.pdf
PL-20-40 is the letter providing guidance for the new rules The new attestation form is at the bottom of this alert letter from HHSC. See the following PDF of PL-20-40: https://apps.hhs.texas.gov/providers/communications/2020/letters/PL2020-40.pdf
HCS Emergency COVID-19 Mitigation Rules
Click on link below to see new rules that were adopted!
HCS/TxHmL Proposed Rules: HCBS Setting Compliant: October 2022
HCS/TxHmL proposed rules should align with the federal HCBS settings rule.
These are currently in the formal comment phase. These comments are due to HHSC on October 17, 2022. To view the rules and instructions for submitting comments, go to the following link: https://www.hhs.texas.gov/regulations/policies-rules/health-human-services-rulemaking/comment-proposed-draft-rules
CARE Migration To TMHP HCS &TxHmL: Updates
October 13th, 2022
Update on Some Migration Issues
Additional Training Resources
Program providers, LIDDAs and FMSAs should create a TMHP Learning Management System account before the webinar to access the LTC Online Portal and claims submissions training. New TMHP LMS users can access the LMS Registration and Navigation Job Aid for Providers (PDF) located on the LMS homepage.
Suggested training resources include:
- HCS and TxHmL Waiver Programs Frequently Asked Questions (PDF)
- LTC Online Portal Basics Computer-Based Training
- TexMedConnect for LTC Providers CBT
- Remittance and Status Reports for LTC Providers Quick Reference Guide (PDF)
- Claim Appeals for Medicaid CBT
- TMHP Claims Video
- TMHP Account Setup for HCS and TxHmL Waiver Programs QRG (PDF)
- LTC User Guide for Online Portal Basics, General Information and Program Resources
- LTC User Guide for TexMedConnect (PDF)
For questions and help navigating the LMS, email TMHP Trainings Support.
March 7th, 2022
Claims Training for CARE Migration:
“TMHP is hosting HCS and TxHmL Waiver Programs webinars on March 22 and March 24 for program providers, LIDDAs, and FMSAs who submit claims on behalf of CDS employers. These webinars will train attendees how to submit and manage claims using TexMedConnect.”
For more info, copy and paste this URL into your browser: https://www.tmhp.com/news/2022-03-09-texmedconnect-claims-submission-training-hcs-and-txhml-programs
February 9th, 2022
More Clarifications From HHSC: Migration During TMHP LTC Online Portal Outage:
February 8th, 2022
Very Important !!!! HCS & TxHmL Providers: Migration of CARE to TMHP
“Beginning March 1, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual developmental disability authority (LIDDA) agencies, and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) employers will submit claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP). It’s important that HCS and TxHmL program providers, LIDDAs, and FMSAs set up their accounts as soon as possible to avoid any delays in payment after March 1, 2022. Program providers, LIDDAs, and FMSAs are strongly encouraged to set up the following accounts if they have not already done so:
- Claims Submission Account
- TexMedConnect or
- Electronic Data Interchange (EDI)
- Long-term Care (LTC) Online Portal
- TMHP Learning Management System (LMS)”
To read more, please click on the link below: Don’t Delay!!!!
Clarifications:
We acknowledge that location errors can be tricky. Below is a list of some CARE screens to check and some hints for fixing the errors, but we know the timeframe will be tight. Please continue to work on these issues when CARE is again available. https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:9c771b69-784f-3fbc-a3b1-054ee1c49e64
September 13th, 2021
New TMHP Account Setup Quick Reference Guide for HCS and TxHmL Providers and FMSAs
The following providers must submit claims and forms to Texas Medicaid & Healthcare Partnership beginning March 1, 2022.
- Home and Community-based Services
- Texas Home Living
- Financial Management Services Agencies billing on behalf of Consumer Directed Services
To submit claims and forms, HCS and TxHmL providers and FMSAs must set up TMHP accounts.
The new TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide is available. The guide provides step-by-step directions to create new TMHP accounts or to link to existing accounts.
It has contact information for help and is available on the TMHP website and TMHP Learning Management System.
Read the notice posted on the long-term care homepage for more information.
September 5th, 2021
New TMHP Migration Implementation Date
A new implementation date of March 1, 2022 is planned for the release of forms and claim submissions to Texas Medicaid & Healthcare Partnership for Home and Community-based Services and Texas Home Living program providers, Local Intellectual Developmental Disability Authority agencies, and financial management services agencies that are billing on behalf of Consumer Directed Services employers.
Until the transition, HCS and TxHmL providers can continue to use the Client Assignment and Registration system for submitting claims and forms.
For more information, read the notice posted on the long-term care homepage.
August 1st, 2021
Claims Submission
Beginning August 2, 2021, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers must submit claims for dates of service on or after August 1, 2021, using Texas Medicaid & Healthcare Partnership (TMHP) online claim submission tools, TexMedConnect or the Electronic Data Interchange (EDI). To become an EDI submitter, visit the TMHP EDI web page for more information. Providers should review the Portal Security Training Manual, and complete the Electronic Data Interchange Agreement for Long-Term Care Providers.
Forms Submission
Beginning August 2, 2021, HCS and TxHmL providers and Local Intellectual or Development Disability Authorities (LIDDAs) must submit forms online through the TMHP Long-Term Care (LTC) Online Portal. These form submission updates will help improve accuracy and will allow for more timely processing and payments for providers.
The following forms will be available for submission on the TMHP LTC Online Portal on August 2, 2021:
• HCS or TxHmL Pre-enrollment
• 8578 Intellectual Disability/Related Condition Assessment
• 8582 TxHmL Individual Plan of Care
• 3608 HCS Individual Plan of Care
• HCS Provider Location Update (PLU)
• Individual Movement (IMT)
• Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments
• Request Individual Update
• Service Coordinator Update
• Initiate Individual Suspensions
• 3615 Request to Continue Suspension of Waiver Program Services
• 3616 Request for Termination of Services Provided by HCS/TxHmL Waiver Provider
Account Preparation and Additional Resources
To prepare for this transition to the TMHP LTC Online Portal, HCS and TxHmL providers that have never used the LTC Online Portal will need an administrator or user account. Providers can find directions for creating an account in the Long-Term Care (LTC) Online Portal Basics computer-based training (CBT) in the TMHP Learning Management System (LMS), and the Long-Term Care (LTC) User Guide for General Information, Online Portal Basics, and Program Resources on the TMHP website and in the TMHP LMS.
Note: To access the LMS, users will need to register for the LMS by clicking the Don’t Have an Account? Sign Up Here button beneath the login field.
HCS and TxHmL providers that use third-party software and third-party vendors to submit claims can register for the TMHP Electronic Data Interchange (EDI). Providers wanting to use EDI will need to complete software testing on the TMHP EDI Testing website.
Additionally, providers are encouraged to visit the TMHP Long-Term Care web page. In the left-hand menu of the LTC web page, providers can find Medicaid and LTC training materials and navigational videos.
Providers can find more information in the “Recent News” section, of the LTC Bulletin in future articles and on the TMHP website.
For any questions related to the HCS & TxHmL Forms and Claims Migration Project, email HCS_TxHmL_Form_Migration@hhs.texas.gov.
For EDI-related questions, call the EDI Help Desk at 888-863-3638.
July 17th, 2021
- The initial effective date of the migration (August 2, 2021) has been postponed.
- At this time HHSC is not able to estimate a new ‘effective’ date, explaining that it needs to first reach 100% compliance in its ‘testing’ phase. HHSC added that as of July 9th, it was at a 65% compliance rate, and that only 44.52% of providers have started the process (referring to registering/setting up a security account and practicing).
- HHSC is using a variety of methods to reach out to providers to remind them of the importance of preparing for this transition.
- HHSC stated there are two options from which providers can choose for claims submission – EDI or Tex Med Connect.
- According to HHSC, choosing EDI allows one to practice using the new system before the effective date.
- Though no details were provided, three (3) additional webinars will be held.
July 3rd, 2021
Migration to the TMHP LTC Online Portal – Aug. 2, 2021 Delayed
May 23rd, 2021
Migration to the TMHP LTC Online Portal – Aug. 2, 2021 Deployment (IL 2021-24)
HHSC has published IL 2021-24 1915(c) Waivers Migration to the TMHP Long-Term Care Online Portal (LTCOP) Preparing for August 2, 2021 Deployment (PDF).
HCS and TxHmL program providers and LIDDAsmust submit the following forms online through TMHP LTCOP beginning Aug. 2, 2021:
- HCS or TxHmL Pre-enrollment
- 8578 Intellectual Disability/Related Condition Assessment (ID/RC)
- 8582 TxHmL Individual Plan of Care (IPC)
- 3608 HCS Individual Plan of Care (IPC)
- HCS Provider Location Update (PLU)
- Individual Movement (IMT)
- Local Intellectual and Developmental Disability Authority (LIDDA) Reassignments
- Request Individual Update
- Service Coordinator Update
- Initiate Individual Suspensions
- 3615 Request to Continue Suspension of Waiver Program Services
- 3616 Request for Termination of Services Provided by HCS/TxHmL Waiver Provider
Forms 8578, 8582, and 3608 with an effective date prior to Aug. 1, 2021, which are not entered into the CARE system before July 16, 2021, will require double entry by the provider or LIDDA into both CARE and TMHP systems.
Helpful Links
TMHP Portal Security Guide: https://www.tmhp.com/sites/default/files/file
library/edi/Portal Security Manual.pdf
•
TMHP EDI website: https://www.tmhp.com/topics/edi
•
TMHP EDI Agreement: https://www.tmhp.com/sites/default/files/provider-
forms/edi/F00021_EDI_Agreement.pdf
•
TMHP LTC User Guide for TMC:https://www.tmhp.com/sites/default/files/file-library/ltc/LTC_TexMedConnect_UG_092420_R.pdf
•
TMHP Provider Education/Training: https://www.tmhp.com/resources/provider-education-and-training
•
TMHP Electronic Visit Verification website: https://www.tmhp.com/topics/evv
•
HHSC HCS and TxHmL Bill Code Crosswalk:
Reminder: Avoiding HCS and TxHmL Overpayment of Services Effective Jan. 2, 2023
October 10th, 2022
Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.
On a quarterly basis, TMHP will calculate all services that have been paid through (CARE) Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount. Read the full alert.
WS&C Mailbox for HHSC To Be Discontinued As of Oct. 31st, 2022
October 10th, 2022
As part of the on-going transformation efforts, HHSC will no longer use the following mailbox, effective Oct. 31, 2022:
For a complete list of current contact information, program providers should refer to PL 2021-26 or e-mail Survey Operations at LTCRSurveyOperation@hhs.texas.gov.
For policy questions related to HCS and TxHmL, providers should e-mail LTCRPolicy@hhs.texas.gov.
IPC Renewals Submissions, Transfers, How To Submit IPC into LTCOP
Timely Submission of IPC Renewals
HHSC reminds HCS and TxHmL providers and local intellectual and developmental disability authorities (LIDDAs) to submit individual plan of care (IPC) renewals for individuals enrolled in the HCS and TxHmL waiver programs as early as program rules allow.
For HCS, renewal IPCs must be submitted at least 30, but no more than 60, calendar days before the current IPC end date.
TxHmL program providers and LIDDAs are encouraged to use the same timeframe for the submission of TxHmL renewal IPCs. Failure to do so can result in delays in processing and service authorization approval.
Important note for individuals transferring:
For a transfer involving two LIDDAs, the individual movement local authority reassignment form must be submitted and processed (status Processed/Complete or PCS Processed/Complete) prior to submission of the transfer IPC.
Guidance on HCS and TxHmL IPC submissions:
Note: There have been no changes in who is responsible for submitting IPCs since the migration of the HCS and TxHmL forms and claims from the legacy HHS Client Assignment and Registration system to the TMHP Long-Term Care Online Portal.
- For information on how to submit forms in the LTCOP portal, refer to Long-Term Care (LTC) Online Portal User Guides for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs: TMHP Learning (exceedlms.com).
Questions:
For policy questions, email your program policy inbox: HCS Policy or TxHmL Policy.
For issues encountered while submitting the IPC on the TMHP Long-Term Care Online Portal, please contact TMHP at 800-626-4117.
Related Conditions: Diagnostic Codes Updated
October 3rd, 2022
HHSC has updated the Approved Diagnostic Codes for Persons with Related Conditions effective Oct. 1, 2022 to Sept. 30, 2023.
The list of diagnostic codes has not changed for this year and can be viewed at HHSC Approved Diagnostic Codes for Persons with Related Conditions.
Important Reminder: HCS/TxHmL Webinar-October 13th, 2022
October 6th, 2022
HHSC will be hosting HCS & TxHmL Updates Provider Webinar on Oct. 13
For: HCS/TxHmL program providers, LIDDA’s, and other interested parties
This webinar will provide information on the following:
- Substantial changes being made to the HCS and TxHmL Program rules.
- IL 2022-49, assessments of HCS three-person residences, four-person residences and host home/companion care settings for compliance with the federal HCS settings rules.
HCS and TxHmL Program Updates Provider Webinar
Oct. 13
1–3 p.m.
Reminder-HCS Provider Applicants: LTC Providers Must Enroll in Texas Medicaid Before They Can Get Their Contract
August 4th, 2022
All New LTC Providers must Enroll in Texas Medicaid. (So, this means even HCS provider applicants, at least once they are nearing the stage of having their application approved and/or at the latest, prior to receiving their contract/s. Remember, you can’t start providing services and accepting clients to your HCS program until you get your letter with the approved contract/s.
- Applicants that intend to bill through TMHP for acute care or long-term care only services must enroll through TMHP.
FYI-New HCS Provider applicants, I would recommend utilizing the “walkthrough assistance” for enrollment.
TMHP offers hands-on assistance with completing and submitting the TMHP enrollment application.
For enrollment walkthrough assistance please contact the TMHP Contact Center (800-925-9126) or TMHP-CSHCN Services Program Contact Center (800-568-2413) or send an email to provider.relations@tmhp.com to request assistance with enrollment questions
Contact Administration and Provider Monitoring
Mail Code W-359
P.O. Box 149030
Austin, TX 78714-9030
- PEMS provider enrollment webpage
https://www.tmhp.com/topics/provider-enrollment - TMHP Contact information
2022 IDEA (Individuals With Disabilities Education Act) Manual
October 5th, 2022
Updated 2022 IDEA Manual
The updated 2022-2023 IDEA Manual is now available in both English and Spanish on the Disability Rights Texas website.
Created in partnership with The Arc of Texas, this manual is designed to help you understand the requirements of the federal Individuals with Disabilities Education Act (IDEA) and Texas law so you can act as an equal partner in planning your child’s education.
Awarded Levels for the Attendant Compensation &DCS Enhancement Programs-2023
October 2nd, 2022
Texas HHSC has posted awarded levels for Long-term Services and Supports (LTSS) providers participating in the Attendant Compensation and Direct Care Staff enhancement programs for state fiscal year (FY) 2023 for the following programs:
Attendant Compensation Rate Enhancement Program for:
- Community Living Assistance and Support Services (CLASS) – Direct Service Agency (DSA);
- Day Activity and Health Services (DAHS);
- Deaf-Blind with Multiple Disabilities Waiver (DBMD);
- Home and Community-based Services (HCBS);
- Primary Home Care (PHC);
- Residential Care (RC);
- Texas Home Living (TxHmL); and
- Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID).
To view the FY2023 enrollment awarded levels list, please visit the PFD website. If you have questions regarding your FY2023 enrollment status, please contact the LTSS Center for Information and Training (CIT) by phone at (737) 867-7817 or by email
Deadline Coming Up Soon For Comments on HHSC Proposed TAC Rules
September 24th, 2022
Deadline for Comments on HHS Proposed Rules Due Oct. 17
Texas HHSC is accepting comments from stakeholders on the following proposed rules, which are now posted in the Texas Register. The comment period ends Oct. 17, 2022.
- Texas Administrative Code,
- Title 40, Part 1, Chapter 9, Subchapter N, repeal of Sections 9.551, 9.552, 9.554, 9.556, 9.558, 9.560 – 9.563, 9.566 – 9.568, 9.570, 9.571, 9.573 – 9.575, 9.582, 9.583, concerning Home and Community-based Services (HCS) Program and Community First Choice (CFC); and
- Title 26, Part 1, new Chapter 262, Texas Home Living (TxHmL) Program and Community First Choice (CFC). Comments can be emailed to HHS Rules Coordination Office.
- Texas Administrative Code,
- Title 40, Part 1, repeal of Chapter 9, Subchapter D, Sections 9.151, 9.152, 9.154 – 9.170, 9.186, 9.189 – 9.192, concerning Home and Community-based Services (HCS) Program and Community First Choice (CFC); and
- Title 26, Part 1, new Chapter 263, Home and Community-based Services (HCS) Program and Community First Choice (CFC). Comments can be emailed to HHS Rules Coordination Office.
Questions can be emailed to HHS Rules Coordination Office.
See TMHP’s LTC Waiver Programs Reference Material Webpage
September 18th, 2022
THMP has website page with reference material for LTC Waiver Programs. See link below:
Updated LTC Online Portal User Guides for HCS and TxHmL Waiver Programs Now Available
Updated LTC Online Portal User Guides for HCS and TxHmL Waiver Programs Now Available
The Long-term Care Online Portal User Guides for Home and Community-based Services and Texas Home Living Waiver Programs have been updated.
The learning path has been updated to include detailed instructions for entering Consumer Directed Services services in dollars instead of units, which were added to the 3608 and 8582 Individual Plan of Care Item-by-Item guides.
Crosswalk Billing Codes For DH -Sept. 2022 Update
September 17th, 2022
EVV Mismatches For DH
Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission
Concern and Issue
HCS and TxHmL providers are receiving unnecessary electronic visit verification (EVV) mismatches for Day Habilitation services due to providers not using proper bill code and modifier combinations based on where services are delivered.
Which day habilitation bill codes do I use?
In-Home Day Habilitation services delivered in an own home or family home setting require EVV visits before billing and must be billed using the following bill codes:
- M0115 – DAY HABILITATION – LN 1 – IN-HOME
- M0116 – DAY HABILITATION – LN 5 – IN-HOME
- M0117 – DAY HABILITATION – LN 6 – IN-HOME
- M0118 – DAY HABILITATION – LN 8 – IN-HOME
- M0119 – DAY HABILITATION – LN 9 – IN-HOME
- M0201 – DAY HABILITATION – LC 1 – IN-HOME
- M0202 – CDS DAY HABILITATION – LC 1 – IN-HOME – Modifier 1 Position UC
In-Home Day Habilitation delivered in a host home or companion care setting, three-person or four-person residence, and Day Habilitation provided outside of the home do not require EVV visits and must be billed using the following bill code and modifier combinations:
- M0421 – DAY HABILITATION – LN 1 – OUT-OF-HOME – Modifier 1 Position – KX
- M0422 – DAY HABILITATION – LN 5 – OUT-OF-HOME – Modifier 1 Position – KX
- M0423 – DAY HABILITATION – LN 6 – OUT-OF-HOME – Modifier 1 Position – KX
- M0424 – DAY HABILITATION – LN 8 – OUT-OF-HOME – Modifier 1 Position – KX
- M0425 – DAY HABILITATION – LN 9 – OUT-OF-HOME – Modifier 1 Position – KX
- M0460 – DAY HABILITATION – LC 1 – OUT-OF-HOME – Modifier 1 Position – KX
- M0461 – CDS DAY HABILITATION – LC 1 – OUT-OF-HOME – Modifier 1 Position – TG
September 17th, 2022
For HCS and TxHmL providers participating in the COVID add-on program, follow the instructions below.
Note: Only program providers delivering in-home Day Habilitation services in a three-person or four-person residence qualify for the COVID add-on program.
In-Home Day Habilitation services delivered in a three-person, or four-person residence do not require EVV visits and must be billed using the following bill code and modifier combinations:
- M0944 – DAY HABILITATION – LN 1 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0945 – DAY HABILITATION – LN 5 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0946 – DAY HABILITATION – LN 6 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0947 – DAY HABILITATION – LN 8 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
- M0948 – DAY HABILITATION – LN 9 – OUT-OF-HOME W/ COVID ADDON – Modifier 1 Position – KX – Modifier 2 Position – CR
Resources
EVV PCS Service Bill Codes Table
HCS and TxHmL Bill Code Crosswalk (for claims with dates of service beginning 05-01-2022)
February 27th, 2022
HCS and TxHmL Billing Changes In The Crosswalk for DH
HCS and TxHmL providers must use the HCS and TxHmL Bill Code Crosswalk starting March 1, 2022 to submit claims for all services. The bill code was updated Dec. 28, 2021.
The HCS and TxHmL Bill Code Crosswalk includes new bill codes for the services that require electronic visit verification.
For HCS program providers:
- Providing out of home day habilitation or in-home day habilitation in a host home or companion care setting, program providers must use the out-of-home day habilitation bill codes.
- Not participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, program providers must use the out-of-home day habilitation bill codes.
- Participating in the COVID add-on program, in-home day habilitation provided in a three-person residence or four-person residence, the program provider must use the out-of-home bill codes below with the modifiers “KX” and “CR.”
- For LON 1: M0944
- For LON 5: M0945
- For LON 8: M0947
- For LON 6: M0946
- For LON 9: M0948
Contact the HCS Policy Box with questions.
HCS Administrative Penalties, Survey, & Billing Requirement Updates
September 17th, 2022
HHSC publishes revised PL 20-55
HHSC Long-term Care Regulation updated Provider Letter 20-55 to include an updated link to the new amelioration form for HCS and TxHmL program providers.
The form is entitled 3708-A HCS and TxHmL Amelioration Request.
May 30th, 2022
HHSC has revised HCS and TxHmL Survey Operations Transformation (PL 21-26)
HHSC revised PL 2021-26 to reflect updates to the HCS or TxHmL Program Manager and Assistant Regional Director contact list.
September 5th, 2021
Now Called Billing Requirements Not Billing Guidelines!!!!
HHSC Publishes Revision 21-3 of the HCS and TxHmL Program Billing Requirements and CFC Billing Requirements
HHSC Publishes Revision 21-3 of the HCS and TxHmL Program Billing Requirements and CFC Billing Requirements
This revision, effective Sept. 1, changes the name from Billing Guidelines to Billing Requirements, and all revisions are outlined in the 21-3 Revision Section of each document.
The Billing Requirements are located on the Long-term Care Providers webpage and Handbooks webpage and are outlined below:
- HCS Billing Requirements (PDF)
- TxHmL Billing Requirements (PDF)
- CFC Billing Requirements for HCS and TxHmL Program Providers (PDF)
Email questions to TxHmL Policy.
September 5th, 2021
Very Important!!! HHSC Releases Guidance Booklet for HCS/TxHmL Providers
Section 4 of House Bill 3720, 87th Legislature, Regular Session, 2021, requires HHSC to develop guidelines for regulatory staff and providers regarding the imposition of administrative penalties. To implement this provision, HHSC is offering training to regulatory staff and providers regarding the certification principles and the administrative penalty criteria and process. In conjunction with these training opportunities, HHSC has developed a comprehensive guidance booklet (PDF) that captures the training content in a user-friendly format. This booklet is available to training participants and on the HCS and TxHmL provider portals. See the registration link below for training webinar presented on September 9th, 2021.
Register for HCS/TxHmL training here.
September 5th, 2021
HHSC Publishes Revised Informal Dispute Resolution (PL 2021-07)
HHSC published a revised version of Provider Letter 2021-07, Informal Dispute Resolution (PDF). A revision was made to update the contact phone number.
August 15th, 2021
HHSC Publishes Revised Guidance for HCS/TxHmL Providers Regarding: How to File a Survey Complaint (PL 20-21)
HHSC has updated PL 2020-01, How to File a Complaint Regarding a Surveyor and Report Survey Inconsistencies (PDF).
The letter has been revised to include information for how HCS and TxHmL program providers can file a complaint regarding a surveyor, how to report survey inconsistencies related to the interpretation and application of regulations and rules, and to provide updated contact information for Long-term Care Regulatory HCS and TxHmL regional program staff.
April 26th, 2021
HHSC’s WS&C Portal
Additional changes are coming to address Surveys and violations received from surveyors. These include contacting WSC staff concerning violations and submitting EOC’s and POC’s to WSC through the WSC Portal!
On April 27th and 29th 2021: HHSC hosted a webinar on WSC Portal Training for HCS/TxHmL providers.
- A recorded session of The WSC portal training
Here are the handouts:
- Basics of portal
- Provider letter 2021-13
- WSC Portal Training Handout
This portal will only be used to enter final PIR Reports, Submit EOC’s (Evidence of Correction), Submit POC’s (Plans of Correction) as well as communicate with WSC staff about POC’s/EOC’s, and Report a Death of an Individual in the program.
- Where do I find the page to create the portal?
- Bookmark this link below, because that is where it will be and it will go live closer to the release of the portal.
- https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/resources/waiver-survey-certification-wsc-provider-portal
March 29th, 2021
March 19 Recording of Clarification of Administrative Penalties and Related Processes Webinar Available
A recording of the March 19, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend.
Listen to the webinar recording here.
March 28th, 2021
March 16 Recording of Clarification of Administrative Penalties and Related Processes Webinar Available
A recording of the March 16, 2021 Clarification of Administrative Penalties and Related Processes for HCS and TxHmL Providers webinar is available for those unable to attend.
Listen to the webinar recording here.
January 10th, 2021
Jan. 5 Recording Webinar Available – HCS and TxHmL Changes to Survey Process and “Hold Harmless Period” Overview
A recording of the Jan. 5, 2021, HCS and TxHmL Changes to Survey Process and Hold Harmless Period Overview webinar is available for those unable to attend.
Listen to the webinar recording here.
Jan. 7 Recording of HCS and TxHmL Administrative Penalties and Amelioration Available
A recording of the Jan. 7, 2021 HCS and TxHmL Administrative Penalties and Amelioration webinar is available for those unable to attend.
Listen to the webinar recording here.
December 28th, 2020
Letter: PL 20-55 Administrative Penalties HCS & TxHmL
https://apps.hhs.texas.gov/providers/communications/2020/letters/IL2020-19.pdf
December 23rd, 2020
Upcoming HCS and TXHmL Webinars For:
“Hold Harmless” Period & Administrative Penalties & Amelioration
Hold Harmless Period Overview
This webinar will cover the “Hold Harmless” period for the new survey process for HCS and TxHmL.
Jan 5, 2021
2 p.m. – 4 p.m.
Here’s the link to record session:
https://attendee.gotowebinar.com/recording/4225828217950682891
For a copy of the handouts, you can email: Shelley.Gusky01@hhs.texas.gov
Administrative Penalties and Amelioration
This webinar will review the new survey process for HCS and TxHmL which begins on March 1, 2021 and will include and overview of administrative penalties and amelioration.
Jan 7, 2021
1 p.m. – 4 p.m.
Register for the webinar.
For a link to the recording of this session and a copy of the handouts, you can email: Shelley.Gusky01@hhs.texas.gov
HHSC Publishes Administrative Penalty Process for HCS & TxHmL Program Providers (PL 20-55)
November 25, 2020
HHSC Long-term Care Regulation has published PL 20-55 – Administrative Penalty Process for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Program Providers (PDF). The PL provides guidance to providers on the rules regarding administrative penalties.
Billing Guideline Changes
The HCS, TxHml, and CFC billing guidelines have been updated effective September 1, 2020. A summary of the revisions can be found on page 25 of the CFC (PDF), page 146 of the HCS (PDF) and page 122 of the TxHmL (PDF). Send questions about the billing guidelines to HCS.TxHml.BPR@hhsc.state.tx.us.
June 20, 2020
Survey Process: Timelines
HHSC Provider User Guide (CARE) 
Please go to the following link:
.
Updated Webinar Resource Document & TMHP Account Setup Quick Reference Guide
September 15th, 2022
Updated Webinar Resource Document and TMHP Account Setup Quick Reference Guide
(HCS and TxHmL Waiver Program Providers)
From HHSC Alert September 12th, 2022
The Webinar Resource document that accompanied the Long-Term Care (LTC) Online Portal Training for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs webinar and the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide have been updated. Read the full alert at Webinar Resource Document and TMHP Account Setup Quick Reference Guide.
Important! (Avoiding HCS and TxHmL Overpayment of Services)
September 12th, 2022
Avoiding HCS and TxHmL Overpayment of Services
Effective Jan. 2, 2023 Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.
On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount.
Read the full alert.
PACSTX LEADERSHIP CONFERENCE-OCT. 26TH-27TH, 2022-SAN MARCOS, TX
From our friends at PACSTX!
2022 Annual PACSTX Conference November 1st & 2nd
Embassy Suites Conference Center
San Marcos, Tx
FOR THE FULL BROCHURE CLICK HERE
TCDD: Deadline For RFA’s For Grants For Persons With Developmental Disabilities
August 23d, 2022
From our friends at the Texas Council for Developmental Disabilities!
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Provider Enrollment & Management System (PEMS)
August 22nd, 2022
PEMS
The Texas Medicaid & Healthcare Partnership (TMHP) is experiencing an unusually high volume of calls and emails from providers with requests for Provider Enrollment and Management System (PEMS) assistance.
As a result, TMHP requests the following of providers requiring PEMS assistance:
- TMHP encourages providers that request PEMS assistance to wait for a call back. Requests are being handled in the order they are received.
- TMHP requests that providers not initiate a second request. Duplicate requests can cause delays.
***Note: Twogether Consulting advises those in the process of getting their HCS provider contract, who are not currently providers, to please call PEMS for “walkthrough services”. Do not try to apply online as you do not have a contract # yet!.
- Provider Enrollment Help on TMHP.com
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
- While waiting for PEMS assistance, providers should refer to the following PEMS educational materials that may assist with PEMS enrollment, re-enrollment, revalidation, change of ownership, and maintenance requests (maintaining and updating provider enrollment record information).
PEMS Training Materials Available on the TMHP Learning Management System (LMS)
The following training materials are available in the PEMS Learning Path on the TMHP LMS to help providers learn how to navigate and use PEMS:
- PEMS webinar recordings
- Provider Frequently Asked Questions (FAQ) about PEMS
- The following computer-based training (CBT) modules:
- “General Information”
- “Resources”
- “New Enrollment”
- “Reenrollment”
- “Provider Management”
- PEMS Video Series
- Video entitled “PEMS vs. PEP” (PEP is the old system and it stands for Provider Enrollment on the Portal)
- “Quick Start Guide to Using PEMS”
- “PEMS Best Practices Guide”
Note: Providers must have a username and password to access the above materials on the LMS. To learn how to obtain a username and password, click here.
Informational Videos Available on the TMHP YouTube Channel
The following videos are in the Provider Enrollment & Management System playlist on the TMHP YouTube channel:
- “The Benefits of PEMS”
- “Removal of TPI from Forms”
- “TMHP Secure User Account”
- “Message Dashboard in TMHP User Account”
- “PEMS Dashboard Overview”
- “PEMS Navigation Panel”
- “Resolving Deficiencies”
- “Start New Enrollment”
- “Adding Attachments”
- “Signing Agreements”
Providers who need help navigating the TMHP website can view the following videos on the TMHP Website Refresher playlist on the TMHP YouTube channel:
- “TMHP Website: Overview”
- “TMHP Website: Provider Manuals”
- “TMHP Website: Provider Relations”
- “TMHP Website: Provider Notifications”
- “TMHP Website: My Account”
- “TMHP Website: Topics”
- “TMHP Website: Programs”
- “TMHP Website: Provider Enrollment”
- “TMHP Website: Resources”
Get More Information
Additionally, the following information related to PEMS is available on the TMHP website:
- “The Benefits of PEMS” guide
- Recent news about PEMS
- Provider Enrollment Help on TMHP.com
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
AAIDD: Annual Texas Chapter Conference 2022
August 15th, 2022
REGISTRATION IS OPEN FOR THE AAIDD: Annual Texas Chapter Conference 2022!
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For more information and registration please click on the link below
Texas AAIDD Conference Registration
Download The Brochure for Agenda, Speakers, Sponsors, and more
Reserve Your Room Today!
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Extreme Drought Conditions
August 14th, 2022
Extreme Drought Conditions
Texas is currently experiencing statewide drought conditions. Numerous water systems are stressed and may continue to experience issues as the drought progresses, and there are concerns about the impacts on long-term care facilities. Water may become limited, in addition due to the extreme heat Texas is using a record amount of electricity so we may be subject to rolling blackouts in the near future. A/C systems are stressed and foundation problems such as cracking have occurred, due to the extreme heat and drought.
LTC providers should review their emergency preparedness and response plans to ensure people know what to do in an emergency related to drought. Confirm contingency strategies are in place and continue readiness for potential issues, including breakdowns associated with water supplies, power supplies and cooling systems.
A few tips from us at Twogether Consulting:
-Don’t wait til the breakdown or disaster occurs, stock up here and there on bottle-watered supplies now, not during a water shortage occurs, and panic has set in at the stores.
-Maintain your A/C/Cooling systems:
- Change the filter regularly. Probably every 2-3 months for most central A/C systems, but check the guidance for your system. With the African dust being so severe, and little rain during the drought, more dust and dirt may be getting into your A/C filter, and trust me, it can shut them down quick this summer.
- Be sure to inform and train your staff at the group homes, if they are persons that need to complete this task.
- If you have maintenance staff, please have them maintain a regular schedule for changing A/C filters for the facility and the group homes.
- If you do not have maintenance staff or others taking care of filters. If the filter is dirty, often that can cause your system to go down.
-If you own some of your own “group homes”, it may be a good idea to purchase homeowner’s insurance now, in case these types of breakdowns occur, as the cost will be much less than paying to fix or even purchase brand new A/C system. Many times they can get someone out to fix the equipment or appliance a lot faster as well with a minimal service charge for coming to fix it. .
-Do you have a backup place the individuals can go, in case the A/C does go out and you can’t repair it quickly?
-Do you have a few bigger size coolers (preferable with wheels for portability), in case the power goes out for a lengthy period of time and you need to ensure your food doesn’t spoil if possible?
-Purchase a backup generator (if feasible &/or appropriate)
-Have your staff check to see if batteries need replacements in flashlights in the group homes.
-Purchase some fans and portable plug-in coolers if A/C system goes out or may go out soon (if feasible &/or appropriate)
Read the news release about the counties currently under the Governor’s Disaster Declaration for Drought and the proclamation from the Governor (PDF).
Visit the HHSC Emergency Preparedness webpage for more information on emergency preparedness for LTC providers.
Revised LTC (Long-Term Care) Region Boundaries
August 8th, 2022
New LTC Boundaries for Survey and Investigation purposes In effect as of August 1st, 2022
HHSC has published Provider Letter 2022-18 – New Regional Boundaries for Long-term Care Providers (PDF).
The letter indicates that HHSC Long-term Care Regulation has redrawn regional boundaries for survey and investigation purposes effective August 1, 2022.
All LTC providers are affected by the new regional boundaries.
Former Region 7 is now separated into two new regions: Region 8 and 11.
Offsite Investigations Requirements Same As Onsite
July 30th, 2022
HHSC Reminds LTC Providers of Offsite Investigation Requirements (PL 2022-15)
HHSC has published Provider Letter 2022-15 – Offsite Review Responsibility Requirements (PDF).
The letter reminds facilities and agencies that they have the same obligation to respond to an investigation that HHSC conducts virtually and offsite as they do during an investigation that HHSC conducts in-person and onsite.
How to Adjust a Previously Adjusted Claim: For Dates Beginning May 1st, 2022 (HCS/TxHmL)
July 30th, 2022
The TexMedConnect User Guide has instructions for adjusting a previously submitted claim with dates of service on May 1 or later. However, the guide does not have instructions for adjusting a previously adjusted claim.
The user guide will be updated to include these instructions. In the meantime, follow the steps in the full alert for adjusting a previously adjusted claim in TexMedConnect.
Non-Waiver Services on The IPC Must Be Entered Into LTC Online Portal (HCS Providers)
July 30th, 2022
Entering Non-Waiver Services in the LTC Online Portal in the HCS Program
Effective immediately, Home and Community-based Services Program providers are responsible for entering all non-HCS Program and non-Community First Choice services into the HHSC data system.
Non-HCS and non-CFC services data are entered in the “Non-Waiver” services tab of the individual plan of care in the Long-term Care Online Portal. During a meeting to develop or revise an IPC, the service coordinator must provide information to the HCS Program provider about all non-HCS and non-CFC services and supports a person receives.
Per 40 Texas Administrative Code Section 9.159(c), an IPC must be based on a person’s person-directed plan. The IPC must specify the type and amount of each HCS service, CFC service (except CFC support management), and the non-HCS and non-CFC services and supports provided during the IPC year.
The service coordinator is still responsible for entering non-HCS and non-CFC services in the LTC Online Portal for HCS services delivered through the Consumer Directed Services option
FAQ’s For ARPA Retention Payments for HCBS & TxHmL
From HHSC:
“The FAQ document has been updated to reflect additional questions that were received during the June 8, 2022 webinar.
Some questions were similar so HHSC combined the main themes of questions received and provided the answer/response below. The FAQ has also been updated to reflect an extension of the deadline for the attestation and initial report. It was July 1, 2022 and has been extended to August 15, 2022.
If you have a question not addressed by this document, please contact: PFDLTSS@hhs.texas.gov.
If you have questions about the HHSC HCBS ARPA spending plan, please contact Medicaid_HCBS_Rule@hhsc.state.tx.us. The webinar recording, which includes a step-by-step walk-through of the attestation and reporting, is available here: https://attendee.gotowebinar.com/recording/8631581217532733954
HHSC is providing a temporary rate add-on for certain home and community-based services delivered between March 1, 2022 and August 31, 2022. Information regarding the temporary rate add-ons can be viewed here: https://pfd.hhs.texas.gov/long-term-services-supports.”
Below is the full FAQ document
https://pfd.hhs.texas.gov/sites/rad/files/documents/long-term-svcs/2022/2022-hcbs-arpa-faq.pdf
ARPA Retention Payments Now Beginning: For Claims Processed in CARE from March 1st-April 30th, 2022
July 27th, 2022
American Rescue Plan Act HCBS & TxHmL Provider Retention Payments
HCBS ARPA Payments in CARE/HCBS Enhanced FMAP Payments in CARE
The Texas Health and Human Services Commission implements American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) provider retention payments.
HCS and TxHmL claims processed on the ID CARE system for dates of service between March 1–April 30, 2022, meeting the eligibility requirements for receiving the ARPA rate add on, will begin to be processed toward the end of July.
Providers will receive three new reports that will include the ARPA add on payments.
NOTE: These same reports are currently being received for regular claim payments under a different Report ID.
Here are the 3 new ARPA reports are provided below:
Approved To Pay Report: HC064110.TXT
Claims Detail Extract: GC063979.TXT
Remittance and Status Report: HC064112.TXT
All providers receiving these ARPA payments will see these new reports delivered every Tuesday morning to their current folders. HHSC is processing payments at the client ID level. Due to the volume of claims, not all providers will receive ARPA payments each week. These ARPA payments will not be viewable within the ID CARE online system at this time but will be reflected in reports.
Questions about the HCBS spending plan can be sent to medicaid_hcbs_rule@hhsc.state.tx.us.
Questions about rates, attestation or reporting: pfd-ltss@hhs.texas.gov.