May 15th, 2023

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

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

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

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

Email questions to: update@hhs.texas.gov

May 14th, 2023

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

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

May 14th, 2023

May 14th, 2023

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

View the full alert here.

May 13th, 2023

Community Attendants & Direct Care/Support Workers:

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

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

Please take time to call:

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

 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.

May 12th, 2023

Important Reminder:  Denial of Medicaid Eligibility

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

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

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

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

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

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

May 2nd, 2023

Infection Control Resources from HHSC

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

Resources Created by HHSC

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

Center for Disease Control and Prevention (CDC)

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

Statewide Program for Infection Control & Epidemiology (SPICE)

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

World Health Organization

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

Agency For Healthcare Research & Quality

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

National Association of County & City Health Officials  (NACCHO)

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

April 27th, 2023

In addition, see following webinar with handout

April 14th, 2023

April 12, 2023 town hall meeting

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

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

PDF handout

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

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

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

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

2022 Cost Reporting:

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

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

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

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

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

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

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

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

ISS Units

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

•260 DH days= 1560 ISS hrs

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

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

April 11th, 2023

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

Training Resources

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

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

Suggested training resources include:

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

For more information, email tmhptrainingsupport@tmhp.com

April 1th, 2023

Link to HCS/TxHmL TMHP Youtube Video Playlist

April 4th, 2023

New HCBS Rules (HCS and TxHmL)

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

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

March 30th, 2023

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

https://www.texasfoundationofhope.org/

 2845 Thousand Oaks Dr.

San Antonio, TX 78232

(210) 265-3351

txfoundationofhope@gmail.com

Office Hours:

Monday – Friday  9:00 AM to 5:00 PM

March 30th, 2023

Review of this important section in 9.174 Service Delivery

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

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

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

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

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

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

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

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

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

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

(i) is a single-action lock;

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

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

March 30th, 2023

Service Delivery Logs for Individualized Skills and Socialization

March 1st, 2023

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

February 21st, 2023

Service Delivery Logs Finally Available for Individualized Socialization Skills Services

March 29th, 2023

 Heightened Scrutiny Process For ISS (Individualized Skills and Socialization)

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

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

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

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

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

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

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

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

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

Questions

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

March 26th, 2023

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

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

March 15th, 2023

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

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

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

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

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

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

Handy Dandy List of Items In The Toolkit:

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

REQUEST TECHNICAL ASSISTANCE WITH HCBS SETTINGS CRITERIA

March 20th, 2023

​88th Legislative Session in Texas!

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

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

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

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

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

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

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

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

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

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

Feb 2023 HB’s

Feb 2023 SB’s

March 2023 HB’s

March 2023 SB’s 

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

March 5th, 2023

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

1915(c) Waiver Interest Lists by Legislative District

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

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

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

Clicking on each district with show more detailed information.

• State House
• State Senate
• Congress

February 27th, 2023

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

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

February 25th, 2023

February 22nd, 2023

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

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

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

February 22nd, 2023

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

February 21st, 2023

Update on Who Qualifies To Assess The Need For A Modification

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

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

February 14, 2023

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

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

IL-2023-05

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

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

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

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

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

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

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

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

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

February 14th, 2023

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

February 10th, 2023

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

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

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

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

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

The training is compiled in four different steps.

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

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

Step 3. Evaluation and Certificates
 Complete the mandatory survey

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

PAT FAQ’s read more

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

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

March 2nd, 2023

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

February 9th, 2023

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

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

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

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

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

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

February 9th, 2023

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

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

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

Specific link to R&S Report Video Series

Specific link to Removal of TPI From Forms Video

February 5th, 2023

Proposed HCS and TxHmL Billing Requirements

January 5th, 2023

IMT and IPC Form Enhancements and IBI Guide Updates Now Available

January 31st, 2023

Advocacy Toolkit from our friends at the ARC of Texas

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

Common Nursing Violations:  Prevention & Correction 

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

(ICF/IID)

The HCS/TxHmL Interpretive Guidance Booklet: Nursing Focus

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

(HCS/TxHmL)

March 2023

Billing Requirement Changes In HCS-2023 Update 

March 29th, 2023  10AM-12:30PM

To Be Determined At A Later Date

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

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

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

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

Pre-recorded sessions are available for purchase!

To Purchase these Pre-Recorded Trainings:

Go to www.twogetherconsulting.com

Or

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

Currently, we have the following pre-recorded sessions:

HCSTxHmL Pre-Recorded Webinar Sessions

Expectations of The Nurse: HCS/TxHmL

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

Care Coordination (5 Part Series)

CARE COORDINATION  (5 Part Series)

Part I  

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

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

Part II   Pre-recorded sessions available for purchase!

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

Part III   Pre-recorded sessions available for purchase!

For HCS & TxHML Providers

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

Part IV   Pre-recorded sessions are available for purchase!

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

Part V  Pre-recorded sessions are available for purchase!

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

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

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

January 27th, 2023

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

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

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

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

Billing Requirements Section 49102.3

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

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

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

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

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

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

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

49102.8 Qualified Service Provider

Revision 23-1; Effective January 1, 2023

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

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

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

November 21, 2022

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

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

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

For more info, please click on the information letter.

January 27th, 2023

HHSC Form Required for Fire Drills for ISS Providers

Click on link below

Form 4719

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

January 16th, 2023

Statewide Transition Plan

January 16th, 2023

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

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

It is unclear when the HCS rules will be adopted.

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

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

January 15th, 2023

TMHP Recoupment Letters

December 12th, 2022

Avoiding HCS and TxHmL Overpayment of Services

Effective Jan. 2, 2023, Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.

On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount.

Read the full alert.

Help With The New Residential Agreements

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

January 12th, 2022

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

See actual TAAIDD link  

January 11th, 2023

RENEWAL OF DETERMINATION THAT A PUBLIC HEALTH EMERGENCY EXISTS

“As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19)  pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective January 11, 2023, the January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021, July 19, 2021, October 15, 2021, January 14, 2022, April 12, 2022, July 15, 2022, and October 13, 2022, that a public health emergency exists and has existed since January 27, 2020, nationwide.”

From the HHSC ASPR website page, this is the alert concerning continuing PHE.  At this time we have no further information on how long this will be ongoing.

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

January 11th, 2023

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

December 06, 2022

Last Friday HHSC posted the ISS rates which may be viewed at the link below.

• The on and off-site ISS rates are effective January 1, 2023. It appears to be unlikely any of the licenses for ISS will be approved by that time.
• The current in and out-of home DH rates will remain effective through February 28, 2023.
• ACRE will not be available for the ISS service.
• This is because the current DH rate is a daily rate; the ISS rate is an hourly rate. 
• Restructuring this component of ACRE will necessitate additional funds which HHSC will be requesting from the 88th Texas Legislature. Unfortunately, once received access to funds will not be available until September 1, 2023 and which providers choosing to participate in ACRE can request during the July, 2023 enrollment period.
• Though the ISS rules have yet to be adopted (hopefully by no later than December 16th), the proposed rules allow persons with a medical or behavioral justification to receive in-home ISS.
• proposed rules also state that if requested, a person who is 55 or older may also receive in-home ISS. 
•  The provider of the in-home ISS service does not need to be a licensed ISS provider.
• Note:  As proposed, the rules do not address whether persons with the aforementioned justification or request can also participate in community activities and bill for off-site ISS.  Though assumed this will not be permitted, we are still waiting for a response.
• The off-site rates allow for two levels of enhanced staffing.  Though the proposed rules did not call for two levels of enhanced staffing, the adopted rules will.
• The adopted rules will also change the ratios at least for the ‘LON 1 and LON 5 without enhanced staffing’ category.

September 27th, 2022

Please see the newly proposed ISS (Individualized Skills & Socialization) rates.  The proposed rates would be effective January 1st, 2023, if accepted, at the following link:  https://pfd.hhs.texas.gov/sites/rad/files/documents/2023/01-01-2023-pmnt-rates-individualized-skills-socialization-%20srvcs.pdf

January 10th, 2023

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

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

SSI/SSDI Benefits Overview

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

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

Employment First

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

• Employment First Training
• Employment First Quiz

Visit the HHS Employment First website.

HCS and TxHmL

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

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

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

Each training has a corresponding quiz.

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

Direct Service Workers

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

• Direct Service Workers Training
• Direct Service Workers Quiz

Core-VA Solutions “Virtual Healthcare Assistants For LTC Programs”

Virtual Healthcare Assistants Services and Training for Long-Term Care Programs, including HCS, TxHmL, and ICF

Free Webinar Series Hosted By: Twogether Consulting (1/10/22 from noon-1pm)

Pre-Registration is required, click on the “Registration” button below to attend this free webinar and complete pre-survey questions!!

REGISTRATION

or Visit our website: www.twogetherconsulting.com and click on the Free Webinar calendar

Twogether Consulting is happy to have Brittney Russo-COO (Chief Operations Officer) from Core-VA Solutions to discuss her company’s “virtual assistant” services.
Core-VA Solutions provides virtual assistance for any type of long-term healthcare setting, whether it be for a small medical office or therapy office or HCS provider. All of our virtual assistants have a degree in nursing and/or health-related fields.

Core-VA is able to serve clients all over Texas and beyond. Some of the clients these virtual assistants work with are those in HCS, TxHmL, and also other IDD programs. This includes assisting with EVV and TMHP billing. Brittney’s team is able to provide appropriate training to her staff to cater to some of your specific needs, including persons with experience in the HCS/TxHmL programs providing some of that training and the IT solutions which they can learn to use using IT fundamentals here to learn for this. They have “virtual assistants” versed in the use of quite a few electronic health records software such as Taskmaster Pro, Focus, and other EHR and billing software. This is a wonderful resource for HCS/TxHmL providers for sure! This is especially true for some of you, who are brand-new HCS/TxHmL providers. Core-VA serves many different clients in other lines of Long-Term Health Services, but it is so nice to have help from a virtual assistant who understands the world of HCS/TxHmL!

-Core-VA team Solutions is part of our free webinar series for the month of January 2023!  Click on their postcard below for more information.  Services are available at $10/hr and no contracts.

core va post card

“Core-VA Solutions aims to positively change how your long-term healthcare facility operates with our virtual assistants with degrees in nursing and/or health-related fields. We understand that you may currently waste precious time and money completing tedious tasks such as medical reception, appointment scheduling, insurance authorization, receiving and submitting medical information, and so much more. Instead of hiring expensive employees to complete these much-needed tasks, hire our affordable virtual assistants instead, as we can provide you with the same level of service, at a fraction of the price. All you have to do is let us know how we can help, and our team will find the perfect assistant match for your facility!”

Improve The Quality of Life

• Balancing personal choice with personal responsibility by establishing and maintaining things that are important to the person with things that are important for the person
• Being integrated in one’s community so that the person is known and respected for her or his contributions.
• Being respectfully communicated with as a person, using language consistent with being a typical adult as opposed to using clinical or system language
• Receiving support that is consistent so that new staff and others know and respect the person’s values and choices, as well as how others can help the person.
• Being matches with staff, housemates, or others that the person making life more enjoyable.

January 2nd, 2023

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

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

2. To apply, you must complete the Provider Applicant Training (PAT). The PAT is now available on the HHS Learning Portal. Do not take the PAT if you aren’t applying for an HCS and TxHmL waiver contract.

• You must get a score of 85% or higher to pass the exam. Lower scores will not be accepted.
• After completing the PAT, you can apply using Form 5873 Waiver and Community-based Programs and Services. Your PAT exam certificate must be included with your application packet. Do not apply without a PAT exam certificate showing your passing score.

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

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

Mail Your Application to the Waiver Program Enrollment Team

Send to this address:

HHSC

Contract Administration and Provider Monitoring

Mail Code W-359 P.O. Box 149030

Austin, TX 78714-9030

Applicants can also submit applications by email: IDDWaiverContractEnrollment@hhsc.state.tx.us or fax: 512-206-3916.

More resources can be found on the HHSC website, including guidance on how to apply and manage your contracts. If you have any questions about the application process, please email us.

January 2nd, 2023

HHSC published an alert on Dec. 21, 2022, informing long-term care providers that expedited delivery is available for a limited time for personal protective equipment through the Texas Division of Emergency Management.

This resource is available to all long-term care providers, including:

• Nursing Facilities
• Assisted Living Facilities
• Intermediate Care Facilities
• Home and Community-based Services
• Home and Community Support Services Agencies, including Community Living Assistance and Support Services, Deaf Blind with Multiple Disabilities, and Medically Dependent Children Program
• Texas Home Living
• Prescribed Pediatric Extended Care Centers
• Hospice
• Day Activity Health Services

Long-term care providers who have a current need for these specific resources can submit requests by visiting star.tdem.texas.gov and selecting the “Expedited PPE” button. The generic passcode for the inventory listed above is: 112518.

Items are available on a first-come, first-served basis. This system is only to be used on a one-time basis for expedited PPE only. If a provider needs these resources, please include the amount needed in your request.

January 1st, 2023

LTC Winter and Extreme Freezing Weather Preparedness

HHSC encourages long-term care facilities and agencies to review and update emergency plans for freezing temperatures and snow. Emergency plans for extreme weather should include the provider’s plan to address:

• Power loss
• Water and food needs
• Communication to families and staff
• Staffing shortages
• Sheltering in place and evacuation as applicable

Providers must follow emergency preparedness rules and their own internal emergency preparedness policies and procedures.

Facilities with generators should perform any maintenance or needed testing while the weather is mild. This will ensure the equipment functions in case of extreme cold or power loss.

It is important to review building integrity and identify any areas that may need repair, reinforcement or weatherproofing. Multi-story buildings should review any other needed measures should evacuation be required and have a plan in place for how to move residents around or out of the building if there is a loss of power.

Preparing for disaster is the most important step in protecting our most fragile Texans and reducing the risk for loss of life.

May 26th, 2022

Guidance related to Emergency Preparedness- Exercise Exemption based on A Facility’s Activation of their Emergency Plan *** Revised to provide additional guidance and clarifications due to the ongoing COVID-19 public health emergency (PHE) REVISED 05.26.2022 ***

Memorandum Summary

• Emergency Preparedness Training and Testing Program Exemption -CMS regulations for Emergency Preparedness (EP) require facilities to conduct exercises to test the facility’s EP plan to ensure that it works and that staff are trained appropriately about their roles and the facility’s processes. During or after an actual emergency, the regulations allow for a one-year exemption from the requirement that the facility perform testing exercises.

• This worksheet presents guidance for surveyors, as well as providers and suppliers, with assessing a facility’s compliance with the EP requirements, in light of many of the response activities associated with the COVID-19 Public Health Emergency (PHE).

• As the PHE continues, many facilities continue to operate under their respective activated emergency plans. Therefore, CMS is providing additional guidance related to the exercise requirements (full-scale/functional drills and exercises) for inpatient and outpatient providers/suppliers.

• This exemption only applies to the next required full-scale exercise (not the exercise of choice), based on the facility’s 12-month exercise cycle. The cycle is determined by the facility (e.g. calendar, fiscal or another 12-month timeframe).

***All revisions are in red on this letter from CMS, click the link below for the complete document. 

Read more……

September 13th, 2021

Very Important Updates on Emergency & Disaster Preparedness During the Pandemic

Resources Listed Are From CMS & HHSC 

See Info For ICF Facilities Below

Life Safety:  Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM)

Emergency Preparedness Participant Workbook

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

Interim Guidance for General Population Disaster Shelters During the COVID-19 Pandemic

Screening Tool For COVID-19 During Pandemic For Arrival At General Population Shelters

Out-of-Hospital Do-Not-Resuscitate Order

Out-of-Hospital Do-Not-Resuscitate (OOH DNR) order.

Both the English and Spanish versions can be downloaded on the EMS and Trauma Systems website, along with “Frequently Asked Questions About OOH DNR,” also in both languages.

For questions related to OOH DNR orders, email EMSInfo@dshs.texas.gov.

December 18th, 2022

 HHSC Long-term Care (LTC) Regulation has retired the COVID-19 Response for ICF for Individuals with an Intellectual Disability or Related Conditions Response Plan and the ICF Frequently Asked Questions documents, effective Dec. 13, 2022.

Facilities can obtain guidance along with resources for infection prevention, control measures, and Personal Protective Equipment (PPE) through the Infection Prevention and Control Measures for Common Infections in LTC Facilities (PDF) and Infection Control Basics & Personal Protective Equipment for Essential Caregivers (PDF) documents published by HHSC.

These resources can also be found on the ICF Provider Portal page.

Program providers may reach out to LTCR Policy with questions at LTCRPolicy@hhs.texas.gov.

December 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.

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.

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!

December 06th, 2022

Please see this alert that was just sent to the 3 IDD associations from HHSC 

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.

Recording of Individualized Skills and Socialization Provider Webinar

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.

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.

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.

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?

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.

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.

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

Overview of GER Reports (Incidents, Injuries, Med Errors…)

Data-Driven:

Person-centered solutions your organization can use to support agency workflows, communication, compliance, organizational outcomes, and revenue management

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October 31st, 2022

Previous Webinars Hosted ByTwogether Consulting:  TaskMaster Pro (TMP) during our free resource webinar series below. 

Just click on the links and register.

October 20th, 2022

https://attendee.gotowebinar.com/recording/1488497278022599682

We couldn’t find an innovative IDD Practice Management software that focused on delivering better care, so we built one!

Software features for Service Providers

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Care professionals are led quickly through documentation processes with platform-assisted data completion. No repetitive entry of information, it’s fast and accurate. Compliance data is gathered and tracked simultaneously. This means compliance reporting can be completed at the push of a button. Thus, caregivers spend more time giving care and less time on paperwork.

January 15th, 2023

Jan. 11th TMHP LTC Migration Webinar

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.

Listen to the Webinar here.

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.

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.

Register for the conference.

For more information, visit the Texas Culture Change Coalition website.

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:

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!

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

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

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.

October 10th, 2022

As part of the on-going transformation efforts, HHSC will no longer use the following mailbox, effective Oct. 31, 2022:

• WaiverSurvey.Certification@hhsc.state.tx.us

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.

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:

• For program rules, refer to 40 TAC §166 for HCS and 40 TAC §9.568 for TxHmL.

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.

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.

October 6th, 2022

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.

October 5th, 2022

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.

Learn more on our Resources for Families page

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

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.

September 18th, 2022

THMP has website page with reference material for LTC Waiver Programs.  See link below:

https://www.tmhp.com/programs/ltc/reference-material

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.

Read the full alert.

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.

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.

Read PL 2021-26 here.

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
  • https://register.gotowebinar.com/recording/recordingView?webinarKey=3385319749029434640&registrantEmail=javasbja%40gmail.com

Here are the handouts:

• Basics of portal
  • Provider letter 2021-13
    • PL-2021-13
  • WSC Portal Training Handout
    • WSC Portal Training Handout with links

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

June 20, 2020

Survey Process:  Timelines

HHSC Provider User Guide (CARE)       

Please go to the following link:

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

.

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.

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.

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August 23d, 2022

From our friends at the Texas Council for Developmental Disabilities!

Last Chance to Apply! The Texas Council for Developmental Disabilities (TCDD) has issued Requests for Applications (RFA) for four new grant opportunities. The deadline to apply for all four RFAs is this Friday, Aug. 26, 2022, by 11:59 p.m. CT.These grants will help expand inclusion, training, and cultural understanding for people with developmental disabilities (DD) in Texas communities. You can learn more about these RFAs on the TCDD Funding Available page and find details on how to apply for them. Disability Cultural Humility Training for Elected Officials TCDD has funding available for one project to develop a training program for elected officials in Texas to better understand people with disabilities. To increase the cultural humility of elected officials and their staff, the project will develop informational videos and materials and a comprehensive yet approachable training program. TCDD has approved funding for up to $150,000 per year for up to five years. Learn More and Apply Self-Advocates in Participatory Action Research  Funding is available to develop Participatory Action Research projects for people with disabilities. All projects must focus on enhancing self-advocate opportunities to have a voice in research about disability issues and increasing connections between researchers and the community. TCDD has approved funding for $150,000 per year, per project, for up to three years. There is funding available for up to two projects. Learn More and Apply Civic Engagement for People with Disabilities  TCDD has funding available to develop a civic engagement training program for people with disabilities. Programs must incorporate disability issues and language that reflect disability culture and strategies for participants to connect with peers, civic organizations, the media, and elected officials. The total funding amount is up to $100,000 per year for up to two years for one project. Learn More and Apply Treatment for Substance-Use Disorders  Funding is available to promote statewide capacity building and systems change improvements in the prevention, identification, and treatment of substance-use disorders among individuals with DD. Projects should include the development of training modules on substance-use disorders for the use of providers specializing in DD as well as modules on DD for the training of substance-use disorder professionals. TCDD has approved funding for up to $150,000 per project, per year, for up to three projects. Learn More and Apply How to Apply Proposals must be submitted through SM Apply. To learn more about TCDD’s RFAs, including the application process and what is required of grantees, visit the How to Apply webpage.

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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.

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:

1. 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.
2. Be sure to inform and train your staff at the group homes, if they are persons that need to complete this task.
3. If you have maintenance staff, please have them maintain a regular schedule for changing A/C filters for the facility and the group homes.
4. 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.

Email questions to LTCR Policy.

August 8th, 2022

New LTC Boundaries for Survey and Investigation purposes In effect as of August 1st, 2022

See new map

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.

Read the PL details.

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.

Read the PL details.

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.

Read the full alert.

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

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

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.

July 18th, 2022

Monthly Reporting Required

REMINDER FROM HHSC: Completion of the Senate Bill 809/Rider 143 Monthly Report is REQUIRED of all participating providers, regardless of whether a provider or facility has received additional federal funding during the reporting month.

All participating providers must complete the Senate Bill 809/Rider 143 Monthly Report every month, even if they did not receive additional federal funds during the reporting month. The reports are due no later than 5 p.m. on the 1^st day of the month following each reporting period. (For example, the report for July 2022 data will be due by 5 p.m. on August 1, 2022.)

HHSC regularly updates the list of healthcare institutions who must submit reports in compliance with Senate Bill 809 or Rider 143. The list can be found here under the SB 809/Rider 143 COVID-19 Reporting Healthcare Institution List dropdown.

Note: this list is derived at a point in time (currently as of July 1, 2022) and not all-inclusive as providers may enroll or change at various times. The list will be updated every Friday by close of business. Any provider that is identified as a “Health Care Institution” as defined in Section 74.001 of the Civil Practice and Remedies Code is required to complete the reports. The list has been updated to align with licensing agencies.

For more information about the Senate Bill 809/Rider 143 Monthly Report, please review this list of frequently asked questions and responses and visit the HHSC Provider Finance Department Communications web page.

If you have question(s) about the content of the report or need technical assistance, please email the HHSC Provider Finance Department at HHSC_PFD_Survey@hhs.texas.gov with “COVID-19 Federal Funds Report” in the subject line.

January 9th, 2022

Reminder: SB 809 / Rider 143 COVID-19 Reporting

The Health and Human Services Commission (HHSC) is posting the list of healthcare institutions, as identified by HHSC, who must submit reports in compliance with Senate Bill 809 or Rider 143. The list also identifies those providers who have not submitted a SB 809/Rider 143 Report. The list can be found on the Provider Finance website under SB 809/Rider 143 COVID-19 Reporting Healthcare Institution List. Note: this list is for the reporting periods of January 2020 – August 2021, September 2021, and October 2021, which were all due 5:00 PM CST on December 1, 2021.

If you believe there is an error in the list, please email us with “SB 809/Rider 143 Reporting” in the subject line by 5:00 PM CST on January 5, 2022.

If all required reports by a provider have not been received by 5:00 PM CST on January 5, 2022, HHSC will begin immediate enforcement of disciplinary actions as authorized by Title 1 Texas Administrative Code Section 355.7201 (TAC) related to the penalties for failure to report. The health care institutions that have “not submitted” are deemed non-compliant at this time.

The initial report required from providers includes funding and cost data covering the period January 2020 through August 2021. The subsequent reports will be ongoing and will cover a single month; each monthly report will be due on the 1st of the second following month following the end of the month (for example, the report for November 2021 data will be due January 1, 2022).

December 30th, 2021

GovDelivery Update: SB 809 / Rider 143 COVID-19 Reporting

This is a notification that HHSC has identified an error in the list of healthcare institutions that have submitted and have not submitted a SB 809 / Rider 143 report. HHSC has now resolved this matter.

HHSC has published a corrected list on the Provider Finance website under SB 809/Rider 143 COVID-19 Reporting Healthcare Institution List.

If you have any questions or concerns regarding this list, please email us with “SB 809/Rider 143 Reporting” in the subject line by 5:00 PM CST on January 5, 2022.

December 14th, 2021

Very Important News! The due dates for the SB 809 Monthly COVID-19 Reports have changed.

Previously the reports were due on the 15th of the month following the month which the report covered.  They are now due on the 1st of the second following month.  Example:  The report covering November is now due January 1, 2022 rather than December 15, 2021. See updated message on HHSC’s webpage below.

The initial report located here includes funding and cost data covering the period January 2020 through August 2021 and is due October 1, 2021. The subsequent reports (located here) will be ongoing and will cover a single month; each monthly report will be due on the 1st of the second following month following the end of the month (for example, the report for September 2021 data will be due November 1, 2021.)

November 30th, 2021

November 14th, 2021

PROVIDER REPORT GRACE PERIOD

HHSC is granting a “grace period” to allow providers time to come into compliance if they fail to meet any deadlines between October 1, 2021, and November 30, 2021. While the deadlines to report will not change, HHSC will not take any of the available actions against a provider as long as the provider submits all the required reports due between October 1, 2021, and November 30, 2021. The grace period ends December 1, 2021.

Because vendor hold can be imposed for lack of compliance and non-compliance will impact a provider’s eligibility to receive the state-controlled ARPA funds made available through SB 8 (Nelson, 3rd Special Session). Please share this information!

Information and FAQs Please visit the HHSC Provider Finance Department Communications web page for more information about the report.  Then click on “Monthly SB 809/Rider 143 COVID-19 Reporting.”

Read More….

October 3rd, 2021

Don’t Forget, The 1st  Monthly Ongoing Provider Report is Due October 15th, 2021!

The ongoing SB 809 and Rider 143 report and further information—including a PDF version of the report questions—are available on the HHSC Provider Finance Department website, and may be accessed on the main webpages for Acute Care Services, Hospitals and Clinic Services, and Long Term Services and Supports. Please note that this Microsoft Form link is separate from the initial report that covered the period of January 31, 2020 – August 31, 2021.

Grace Period

HHSC is granting a “grace period” to allow providers time to come into compliance if they fail to meet any deadlines between October 1, 2021, and November 30, 2021. While the deadlines to report will not change, HHSC will take no action against a provider as long as the provider submits all required reports due between October 1, 2021, and November 30, 2021, prior to the end of the grace period. The grace period ends December 1, 2021.

Sept. 18th, 2021

FAQ’s For Compliance With SB809 & Rider 143: Monthly Provider Reporting Requirements Concerning COVID-19 Funding

Introduction:

The 87th Texas Legislature directed the Health and Human Services Commission (HHSC) to report federal COVID-19 funding from specific health care institutions, and certain costs those providers have spent related to COVID-19 public health emergency. HHSC has developed a monthly report to obtain the information required by Rider 143 (.pdf) (2022-23 General Appropriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular Session, 2021 (Article II, HHSC, Rider 143) and S.B. 809 (.pdf) (87th Legislature, Regular Session, 2021).

Frequently Asked Questions (FAQ):

View the HHSC created list of “frequently asked questions ” (FAQ) (.pdf) with the answers to common questions to assist providers in completing the report.

Reporting: 

The initial report located here includes funding and cost data covering the period January 2020 through August 2021 and is due October 1, 2021. The subsequent reports will be ongoing and will cover a single month; each monthly report will be due on the 15th of the month following the end of the month (for example, the report for October 2021 data will be due November 15, 2021.

You will receive a confirmation once your report has been fully completed and submitted.

A pdf version of the report is available here (.pdf) for review prior to submitting the report.

If you are unable to meet the reporting deadline please contact the Provider Finance Department at HHSC_RAD_Survey@hhs.texas.gov for assistance.

Failure to submit:

Failure to complete and/or submit the required monthly report(s) on time will result in:

1. A report to the Department of State Health Services or HHSC Regulatory Services and potential adverse actions on your licensure and/or
2. HHSC may initiate payment holds for providers who fail to submit the required monthly reports.

HHSC is granting a “grace period” to help providers come into compliance if they fail to meet any deadlines between October 1, 2021, and November 30, 2021. While the deadlines to report will not change, HHSC will not any of the actions listed above against a provider as long as the provider submits all the required reports due between October 1, 2021, and November 31, 2021. The grace period ends December 1, 2021.

List of Some Of The Providers Required to Complete Reports: 

Here are some of the following entities that are required to complete the report:

• Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID);
• Community Living Assistance and Support Services (CLASS) or Case Management Agency (CMA) Providers;
• Deaf-Blind with Multiple Disabilities (DBMD) Providers;
• Home and Community-Based Services (HCS) Providers;
• Texas Home Living (TxHmL) Providers;

Please email the HHSC Provider Finance Survey for assistance at HHSC_RAD_Survey@hhs.texas.gov.

September 18, 2021

As required by Senate Bill (SB) 809 and Rider 143 of the 87^th Legislature (regular session)(copied below), HHSC will begin collecting information on the total value and uses of COVID-19 related Federal funds through monthly reports. The first report is due October 1, 2021. Reminder of Publication of Proposed Rules

HHSC published proposed rules related to SB809 and Rider 143 in the Texas Register on August 13, 2021, pages 4928-4931. The comment period ends September 3, 2021.

Rider 143

Reporting Requirement: COVID-19 Funding to Nursing Facilities and Hospitals. Out of funds appropriated above in Strategy B.1.1, Medicaid Contracts and Administration, the Health and Human Services Commission (HHSC) shall develop a report detailing the total value and uses of COVID-19-related Federal Funds, including Provider Relief Funds, provided directly to nursing facilities and hospitals contracting with HHSC since the beginning of the public health emergency. The report should include any temporary rate increases provided to nursing facilities related to the COVID-19 pandemic. Any facilities that do not provide information requested by the commission necessary to complete the report shall be identified in the report. The first submission of the report shall also include a description of any requirements implemented for nursing facilities in response to the COVID-19 pandemic, the cost to nursing facilities to implement the requirements, and recommendations on whether or not the requirements should be continued after the end of the public health emergency. HHSC shall submit the report to the Governor, Legislative Budget Board, and any appropriate standing committee in the Legislature on December 1st and June 1st of each fiscal year. The format and content of the report shall be specified by the Legislative Budget Board and posted on the HHSC website. Appropriations in Strategy A.2.4, Nursing Facility Payments, for fiscal year 2023 are contingent on the submission of the reports due December 1, 2021 and June 1, 2022.

Please look for forthcoming announcements from HHSC regarding these important reporting requirements. For more information, please contact HHSC Provider Finance.

July 14th, 2022

Important Medicaid Coverage-Don’t Wait-Please Respond to Medicaid Letters- Changes To Occur in Medicaid Coverage

After Public Health Emergency Ends

This information letter gives service coordinators, case managers, and providers information to help individuals prepare for ending continuous Medicaid coverage. HHSC requests providers support the information campaign –Don’t Wait –Respond and Update! –by communicating with individuals and incorporating campaign materials into Medicaid operations.  In otherwards, our individuals currently covered, may not automatically be qualified as covered once PHE ends.  Act now and respond to all Medicaid letters telling you that your individual may not qualify when PHE ends.  Shout out to all SC’s and Case Managers!

PL-2022-39

https://www.hhs.texas.gov/sites/default/files/documents/il-2022-39.pdf

July 10th, 2022

Date: October 1st, 2022 (San Antonio, Tx) 

2022 AccessAbility fest & abilitySTRONG Parade

REGISTRATION IS NOW OPEN!

It’s time to REGISTER!  At disABILITYsa, we are excited to host the 16th Annual AccessAbility fest and abilitySTRONG Parade on Saturday, October 1st, 2022 at Hemisfair.

Early bird discounts end on August 15^th, 2022!

* Sponsorship Opportunities * Exhibitor Registration * Parade Entries * Program Partners * Information Only * and more! *

You will have a front-row seat to share your programs, resources, and opportunities to every individual, caregiver, and other providers in attendance. Every attendee will be able to interact through the AccessAbility fest gateway to resources, opportunities and recreation for individuals facing barriers to independence and inclusion due to a physical, developmental, sensory, and/or mental health challenge.

SATURDAY, OCTOBER 1ST, 2022 Schedule of Events
9:00am – 10:00am
abilitySTRONG Parade
9:00am –  2:00pm
Resource Festival
10:30am 
Main Presentation/Ceremony

The deadline to REGISTER as an exhibitor and be guaranteed an exhibitor booth is Friday, September 2^nd, 2022 at 5pm.

We look forward to you joining us for our 16th Annual AccessAbility fest, should you have any additional questions you are welcome to email lisa@disabilitysa.org or call the office at 210-704-7262 or email Kameron Chicoine at kameron.exceptionalkids@gmail.com.

CLICK LINK TO REGISTER: https://hipaa.jotform.com/221468522820150

Juliy 11th, 2022

Our good friend at IntellectAbility, Patrick Lane has provided a link where providers or anyone else interested can register for online Person-Centered Thinking training.  FYI-this is a requirement in the HCS/TxHmLTAC rules for all persons who are a part of the development of the Implementation Plan (IP), to have this training within the first 2 year of hire.

Staff Member and Service Provider Requirements

The session is a $275 per person.

This is a 3-day series of zoom sessions, each 6 hrs long.

There are multiple live Zoom training dates listed, so take your pick.

https://replacingrisk.com/virtual-person-centered-thinking-training/ 

To learn more about IntelectAbility, here is their main website page https://replacingrisk.com/

TAC 9.177 (d) A program provider must:

  (1) conduct initial and periodic training that ensures staff members and service providers are qualified to deliver services as required by the current needs and characteristics of the individuals to whom they deliver services, including the use of restraint in accordance with §9.179 of this subchapter (relating to Certification Principles: Restraint); and

  (2) ensure that a staff member who participates in developing an implementation plan for CFC PAS/HAB completes person-centered service planning training approved by HHSC:

    (A) by June 1, 2017, if the staff member was hired on or before June 1, 2015; or

    (B) within two years after hire, if the staff member was hired after June 1, 2015.

July 11th, 2022

Thought this was great info. and wanted to share-

From IntellectAbility

Long-haul COVID in People with IDD

“People with intellectual and developmental disabilities (IDD) are at a greater risk of infection and poorer COVID-19 related health outcomes than the general population. Prevalence of comorbidities, living in congregate settings, and difficulties practicing preventative measures contribute to this risk; however, the inability to effectively communicate symptoms of illness may be the most significant hurdle to identifying and managing symptoms of COVID-19 infection, especially for those experiencing the lasting effects of long-haul COVID.”

Read more

Download this 10-page document for more info on symptoms in individuals with  “Long-haul COVID-19” issues