May 5th, 2022

Please see the link below for updated Service Delivery Logs for 05/2022 in Billing Requirements Handbook on page 185.

Billing & Payment Billing Requirements For HCBS Waiver

For questions about HCBS Program Billing Requirements, please email:   hcspolicy@hhs.texas.gov

April 28th, 2022

Very Important!

Recorded Webinar For Claims Submission in TMHP

Below is the link to the recording of the claims submission webinar TMHP conducted.   Additional information about the migration will be sent under separate cover.

Note:  HHSC will not conduct another webinar on claims submission!

 https://tmhp.exceedlms.com/student/enrollments/create_enrollment_from_token/fEmzWuXLDuXzfc3jncsErHWU

March 1st, 2022

HCS and TxHmL Programs Forms and Claims Submissions to TMHP Available March 1, 2022

April 28th, 2022

• Attached are handouts from the November, 2021 and February, 2022 joint meeting of the IDD SRAC and STAR+PLUS Pilot Program Workgroup related to the pilot and decisions (including eligibility) made thus far.
  • See pages 52 – 102 of the February, 2022 document for information about the pilot.
• HHSC has created a webpage on the Pilot Program.
  • The link to this webpage is:  https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus-pilot-program-sp3

April 28th, 2022

April 28th, 2022

Details On Hearing

Date, Time & Location:  Thursday, May 5, 2022 at 10:00 a.m., Capitol Extension, E2.030

Purpose:  To receive invited testimony on several of its interim charges:  #1 related to Healthy Families and Healthy Texas Initiative. When looking at healthy aspects of families, everything from hygiene to food, especially food since lots of people ask is mazola corn oil healthy?  These are all related to the 1115 Waiver, and, the one of importance to PPAT members,  related to implementation of SB1, Rider 30 (HHSC) and recommendations for reducing the interest list for waiver services for Individuals with IDD and reducing associated staffing shortages. See end of this message for text of Rider 30.

Organizations Invited to Testify: Though not inclusive, organizations invited to provide testimony include PPAT, the Texas Council of Community Centers, the Arc, Disability Rights Texas and PACSTX.  HHSC will also provide testimony.

April 20th, 2022

• HHSC will hold a public hearing on the rules this summer.  Date and time not shared by HHSC yet.
• Lengthy discussion regarding the proposed provision related to lease agreements and the potential for eviction if R&B payments are not received, has occurred.
  • A process is needed to ensure Providers receive R& B payments
    • However, It is clear that further discussion regarding the proposed process/requirement is needed.

April 16th, 2022

Effective April 16, 2022 the Public Health Emergency (Pancemic) has been extended another 90 days.  This means, that if not terminated during that 90-day period, it will either end July 15, 2022, or, if deemed necessary, will be extended for another 90-day period

April 13th, 2022

Texas Providers have been reminded that they can be surveyed at any time by a CMS/Federal Surveyor and will need to be in compliance if this occurs.

In short, at this time, HHSC Regulatory will not survey for compliance with the federal mandate.

The federal mandate and HHSC position apply to certified-only HCSSAs, Hospice, Nursing Homes and ICFs/IID. 

April 12th, 2022

• The program rules will go to MCAC on August 11, 2022. 
• The regulatory or license rules will go to the HHSC Executive Council but no date set yet.
• The program and regulatory rules will be published in the Texas Register for formal comment in late July, and HHSC will hold a public hearing on the rules.
• HHSC has decided to eliminate the on-site ratios.
• Though the off-site ratios have not been eliminated, HHSC is considering revisions to them and open to suggestions and ongoing dialogue.
• The current draft rules do not require any benchmark regarding time persons must engage in off-site activities, and at this time, there is no consideration to establish benchmarks.  According to HHSC, this is in great part due to the limited amount of appropriations received to implement the new service.
• No changes expected, at least for now, to the proposed rates.
• At this time, no changes to the DH rates for persons enrolled in an ICF/IID, yet who will attend an ISS facility are anticipated to occur.
• Based on comments received through the informal comment period, HHSC is restructuring and revising the draft regulatory/license rules.  Details were not provided.
• Stakeholders requested consideration of a separate meeting to discuss the draft rules.  No confirmation received as to whether HHSC will schedule a meeting.
• HHSC has created a webpage related to ISS.  To access, go to: https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/individualized-skills-socialization

April 10th, 2022

Individualized Skills and Socialization

IDD Systems Redesign Committee (SRAC) Agenda from January 27th, 2022

See link below or read the section below.  The webcast recording is available below:

March 7th, 2022

 (See link below to FAQ’s)

Answers to Additional Questions related to the Migration

March 10, 2022

Draft of ISS Rules below:

• Texas Administrative Code, Title 26, Part 1, Chapter 559, Subchapters A and H, Individualized Skills and Socialization

Email comments before March 28th, 2022 to Long-term Care Regulation Policy and Rules.

March 9th, 2022

CARE Banner In CARE system for HCS/TxHmL providers:

March 7th, 2022

Public Comment Period for STP

HHSC will submit a Statewide Transition Plan to the Centers for Medicare and Medicaid Services. This is required by the federal Home and Community Based Services Settings Rule. The STP describes HHSC’s plan to meet the requirements of the HCBS Settings Rule.

HHSC invites members of the public, including HCBS recipients and their families, providers, and other stakeholders, to submit comments on the STP.

Comments will be accepted until 11:59 pm on April 4, 2022. Access the STP and instructions for submitting public comments here.

March 4th, 2022

If you attended the 2/9/22 Plans of Correction (POC’s) training webinar for HCS & TxHmL, here are the answers to some of the follow-up questions asked during the session: 

Q: I have experienced that the POC has a date that is 8 days in the past but the postage stamp would be 2 days ago. This leaves me with 6 days to complete the POC. Do I use the date on the letter or the postage date for the 14-day time period?

A: §9.183(f) states the program provider must submit the POC within 14 calendar days of receiving the final report for each violation identified in the plan of correction. The start date of the 14 days is when the program provider receives the final survey report, not the date of the letter or the postage date. The final report can be emailed to the program provider if the email address is on file.

If you have specific questions about the due date for the POC, please contact your regional program manager.

Q: Can we sign the 3724 electronically?

A: If the program provider has the capability to electronically sign, this is acceptable.

Q: Isn’t HHSC supposed to send the provider a pdf or word version of the violations that the provider can actually edit on the right side to enter in their POC’s?  That seems to be an issue some providers have had.

A: Form 3724s are e-mailed to program providers PDF format. A program provider should be able to edit the PDF to enter their POCs on the right-hand side. Please see Instructions for Electronic 2567/3724 for how to do this. If you’re still having trouble, you can contact your regional program manager.

Q: If the 3724 is mailed to the provider in a protected PDF format, how can the provider type the corrections on the form if they do not wish to hand write them?

A: Please contact your regional program manager.

Q: Can a POC be completed in the HCS portal?

A: No, the POC cannot be completed in the provider portal. The POC information needs to be entered on the final 3724 report that is submitted to the program provider.

Q: Are those letters certified to verify when the letter was actually received by the provider?

A: No, the letters are not required to be certified.

Q: I was told there are no debriefings during the survey process. Has this changed?

A: The surveyor will review Form 3701-A, Statement of Preliminary Findings during the survey exit conference to review each of the areas of noncompliance that were identified during the course of the survey, including findings that may result in a critical violation. Per §9.171(j), if HHSC identifies a finding that may be a critical violation not discussed during an exit conference, a new exit conference with the program provider will be held to discuss those additional finding(s).

Q: Is this Form 3724 that is used in the ICF Program as the CAP replacing Form 8581 that was previously used in the HCS and TxHmL Program as the CAP?

A: Form 3724 should be used for Plans of Correction for the HCS program. Form 3724 is the state form from ASPEN for the Statement of Licensing Violations and Plan of Correction.

Form 8581, Corrective Action Plan has been retired and removed from the HHSC website.

Q: Will HHSC surveyors provide a separate form for administrative penalties for any violations not corrected?

A: All violations must be corrected before the imposition of penalties. If violations aren’t corrected the provider will be decertified. Decertification triggers contract termination. 

Enforcement notifies the provider through certified and first-class mail of the imposition of penalties.

Q: Is the IDT the same as the SPT (service planning team) for HCS and TxHmL?

A: The concept is similar. Per 40 TAC 9.153(106), the definition of a Service Planning Team is

“One of the following:

(A) for an applicant or individual other than one described in subparagraphs (B) or (C) of this paragraph, a planning team consisting of:

(i) an applicant or individual and LAR;

(ii) service coordinator; and

(iii) other persons chosen by the applicant or individual or LAR, for example, a staff member of the program provider, a family member, a friend, or a teacher;

(B) for an applicant 21 years of age or older who is residing in a nursing facility and enrolling in the HCS Program, a planning team consisting of:

(i) the applicant and LAR;

(ii) service coordinator;

(iii) a staff member of the program provider;

(iv) providers of specialized services;

(v) a nursing facility staff person who is familiar with the applicant’s needs;

(vi) other persons chosen by the applicant or LAR, for example, a family member, a friend, or a teacher; and

(vii) at the discretion of the LIDDA, other persons who are directly involved in the delivery of services to persons with an intellectual or developmental disability; or

(C) for an individual 21 years of age or older who has enrolled in the HCS Program from a nursing facility or has enrolled in the HCS Program as a diversion from admission to a nursing facility, for 365 calendar days after enrollment, a planning team consisting of:

(i) the individual and LAR;

(ii) service coordinator;

(iii) a staff member of the program provider;

(iv) other persons chosen by the individual or LAR, for example, a family member, a friend, or a teacher; and

(v) with the approval of the individual or LAR, other persons who are directly involved in the delivery of services to persons with an intellectual or developmental disability.

Q: What do we do if the 45-day PoC completion date has already passed by the time we get the final report?

A: If you receive the final report near or after the 45-day PoC completion date, please contact your regional program manager for assistance.

Instructions for Documenting Your POC’s On Electronic Form 2567/3724 Received From HHSC

Provider:

1. Open the 2567/3724 document
2. Go to “Insert” on the toolbar
3. Select “Text” Box
4. Insert the “Text” Box where you want to write the PoC
5. Insert a second “Text” Box where you put the PoC date.
6. Right-click on the text box’s border, and choose “copy”.  (For copy and pasting)

7. Scroll down to the second page of 2567, left-click anywhere on the page, then press “Ctrl-V” on the keyboard

                           ( or right-click with the mouse and choose “paste” ) – the text box will paste in nearly centered into the POC field

                            ( to center, press two cursors spaces to the left and two cursor spaces up ).

Repeat on the remaining pages

Save the document.

Send the document back to the region.

LTC Providers May Need to Update Fire Alarm System Cellular Communication Services

In 2022 cellular companies will retire their older 3G technology. These companies include T-Mobile, Sprint, Verizon and AT&T.

LTC providers relying on fire alarm systems that utilize outdated cellular communicators operating on 3G networks must consider upgrading their fire alarm communication apparatus. The majority of these systems depend on cellular communication devices to dispatch signals to a 24-hour central monitoring station, which in turn, alerts the local emergency services to provide assistance. Should your system’s cellular communicator be based on 3G technology, and with cellular providers phasing out 3G support, your setup could fail to alert emergency services in the event of a fire. This highlights the critical need for ensuring your fire alarm system is up-to-date, not only for effective emergency communication but also for integrating seamlessly with Fire Watch Security in NYC, ensuring a comprehensive approach to fire safety and emergency response.

The major cellular companies gave the following dates for retiring their older networks:

• AT&T began retiring its 3G network on Feb. 22, 2022.
• Sprint will retire its 3G CDMA network on March 31, 2022.
• Sprint will retire its 3G LTE network on June 30, 2022.
• T-Mobile will retire its 3G UMTS network on July 1, 2022.
• Verizon will retire its 3G CDMA network on Dec. 31, 2022.
• T-Mobile has announced it will retire its 2G GSM network but has not set a date for that retirement.

After these dates fire alarm communication devices that connect to cellular communication systems using this older technology will not work.

LTC providers are responsible for ensuring their fire alarms systems function correctly. Providers with fire alarm systems monitored by a third-party monitoring company should contact their fire alarm service company. They need to find out if their fire alarm communication equipment needs upgrading.

Email LTCR Policy or call 512-438-3161 with questions.

March 1st, 2022

HCS and TxHmL Form Submission on LTC Online Portal Unavailable Until May 1, 2022

Due to Postponement, submissions of Home and Community-based Services and Texas Home Living forms using the Texas Medicaid and Healthcare Partnership Long-Term Care Online Portal are unavailable until May 1st, 2022. Data migration to the TMHP LTC Online Portal took place prior to March 1st, 2022.

FYI-Any HCS and TxHmL form submitted to the LTC Online Portal before March 1 could be removed and require resubmission May 1st, 2022.

Beginning May 1, submit HCS and TxHmL forms using the TMHP LTC Online Portal. All user guides to aid form submissions are published to TMHP’s Learning Management System. All users must create an LMS account to access the materials. There is a sign-up link on the LMS homepage. Contact TMHP Training Support if you need help.

Providers can refer to the article, “Reminder: Beginning March 1, 2022, HCS and TxHmL Programs to Submit Claims and Forms to TMHP” for more information about the transition to TMHP, which now applies to May 1st, 2022.

Email questions to TMHP.

February 27th, 2022

HCS and TxHmL Webinar Slated for March 3 moved to March 10th, 2022

Program providers and other interested stakeholders can now register for the upcoming HCS and TxHmL webinar.

Webinar topics include:

• HCS & TxHmL Forms and Claims Migration Project
• Critical Incident Management System

HCS and TxHmL Webinar
March 10, 2022
3:30 – 4:30 p.m.
Register for the webinar

Email questions about the webinar to your program policy mailbox:

• • HCS Policy
  • TxHmL Policy

February 26th, 2022

If you missed part II of the LTC TMHP Migration HCS & TxHmL Waiver Webinar Training, you will have an additional chance on March 10th, 2022

10am-12:30pm Central

Please click here register here

The Long-Term Care (LTC) Online Portal Training for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs is a two-part webinar for providers and Local Intellectual and Developmental Disability Authorities (LIDDAs).

Attendees can register for any of the first sessions, and any of the second sessions; but are strongly encouraged to complete the first session before attending the second session.

Part 2 of this webinar will cover the following topics:

• Purpose and Workflow of the 3608/8582 Individual Plan of Care (IPC) Form

• Purpose and Workflow of the Individual Movement (IMT) Form

• Purpose and Workflow of the 3615 Request to Continue Suspended Services Form

• Purpose and Workflow of the 3616 Request for Termination of Waiver Program Services Form

• Purpose and Workflow of the HCS Provider Location Update (PLU) Form

• Navigation of the LTC Online Portal • Available HHSC and TMHP resources for providers and LIDDAs This webinar will not provide billing training.

***For more information about billing with TMHP, refer to the Learning Management System (LMS) at learn.tmhp.com, and search for TexMedConnect or Claims in the keyword search feature.

February 26th, 2022

Additional Training Resources From TMHP

It is highly recommended that program providers, LIDDAs, and FMSAs create a TMHP Learning Management System (LMS) account at learn.tmhp.com before the webinar 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, contact tmhptrainingsupport@tmhp.com

February 8th, 2022

For those of you who missed today’s training (part I) or who did not download the documents, I have provided them on this “Updates” post from Twogether Consulting

Link to Resource Document from Webinar on 2/8/22 (TMHP Training Part I)

Webinar Handout Part I Training 

LTC TMHP Portal Provider User Guide

TMHP Migration (HCS & TxHmL) FAQ’s

This webinar will be repeated on March 8th, 2022

---

The Long-Term Care (LTC) Online Portal Training for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs is a two-part webinar for providers and Local Intellectual and Developmental Disability Authorities (LIDDAs). Attendees can register for any of the first sessions, and any of the second sessions; but are strongly encouraged to complete the first session before attending the second session.

Part 1 of this webinar will cover the following topics:

• Management of waiver program assessments and forms in the LTC Online Portal

• Purpose and Workflow of the HCS/TxHmL Pre-enrollment Form

• Purpose and Workflow of the 8578 Intellectual Disability (ID)/Related Condition (RC) Assessment

• Purpose and Workflow of the 3608/8582 Individual Plan of Care (IPC) Form • Available HHSC and TMHP resources for providers and LIDDAs

February 13th, 2022

HCS/TxHmL Providers & LIDDA’s: Client Assessment, Review, and Evaluation (CARE) Report and Screen Crosswalks Now Available

The CARE report and screen crosswalks for HCS, TxHmL providers and LIDDAs are now available to assist with daily operations.

Click the following link to view the files:

Provider and LIDDA CARE Report Crosswalk

Provider and LIDDA CARE Screen Crosswalk

HCS and TxHmL providers will use these crosswalks to locate relevant individual and provider data needed for day-to-day operations beginning March 1, 2022.

If you have questions, contact the HHSC HCS TxHmL Form Migration mailbox at HCS_TxHmL_Form_Migration@hhs.texas.gov.

February 13th, 2022

HHSC Publishes Information on data migration from the CARE system to the to the TMHP LTC Online Portal (IL 2022-12)

HHSC has published IL 2022-12 that provides information to HCS and TxHmL Program Providers and FMSAs about the CARE screens that are unavailable from Feb. 9 (5:00pm) to March 1, as data is migrated from the CARE system to TMHP LTC online portal.

It also provides information about form submissions after Feb. 9, and HCS and TxHmL claims submission for services delivered prior to March 1, and on March 1, or later.

Submit question about HCS & TxHmL Forms and Claims Migration Project here.

February 13th, 2022

Inactive Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Provider Client Assignment and Registration (CARE) Screens

Due to the HCS and TxHmL migration to Texas Medicaid and Healthcare Partnership (TMHP), the following CARE screens will be inactive beginning 9 p.m. Wednesday, Feb. 9, until Monday, Feb. 14.

L01 — CONSUMER ENROLLMENT
L02/C02 — INDIVIDUAL PLAN OF CARE
L03 — ENROLLMENT PACKET CHECKLIST
L05 — PROVIDER CHOICE
L06 — CONSUMER TRANSFER
L23/C23 — WAIVER ID/RC ASSESSMENT
L30 — MRA ASSIGNMENT NOTIFICATION
L31 — HCS IPC MRA REVIEW (HCS)
L32 — ID/RC ASSESS MRA REVIEW (HCS)
C18 — INDIVIDUAL DISCHARGE
C29 — MODIFY PROVIDER SERVICE AUTH

Below are screens that will be inactive and retired as of Feb. 10.

Note: Providers will not be able to submit entries until effective Feb. 16. Effective Feb. 16, Wait List and SLOT will be entered into SLOT and CSIL.

A20 — AUTHORIZE LOCATIONS
A29 — SLOT TYPES
A30 — SLOT ALLOCATION
A31 — SLOT STATUS UPDATE
A32 — SLOT ALLOCATION REMOVAL
A40 — RATE OPT OUT
A58 — WAIVER ID/RC ASSESSMENT(E)
A71 — WAIVER SLOT AVAILABILITY
A73 — SLOT TRACKING

L20 — GUARDIAN INFORMATION UPDATE
L26 — CLIENT ASSIGNMENTS
L61 — WAIVER SLOT COUNTS
L62 — WAIVER SLOT DETAIL
L64 — IPC EXPIRATION
L65 — ID/RC ASSESSMENT EXPIRATION

C20 — GUARDIAN INFORMATION UPDATE
C24 — LOCATION
C25 — LOCATION TYPE MODIFICATION
C26 — CLIENT ASSIGNMENTS
C64 — IPC EXPIRATION
C65 — ID/RC ASSESSMENT EXPIRATION
C75 — PRIOR APPROVAL
C88 — CONSUMER HOLDS
W21 — INTEREST LIST UPDATE
W27 — TRAVIS QUESTIONNAIRE ENTRY
W28 — TRAVIS QUESTIONNAIRE SEARCH

For questions or information, see:

• Portal Security Manual — Explains how to access TMHP systems (PDF)
• TMHP Learning Management System (LMS) — Register for an account
• TMHP Learning Management System (LMS) — Register for an account
• Computer Based Training for:
  • Portal Basics
  • TexMedConnect Claims Entry System
• Provider User Guide for the LTC Online Portal published on tmhp.com.
• Item-by-Item Guides for each HCS and TxHmL form published on tmhp.com.

February 8th, 2022

CBT (Computer Based Training) For TMHP Billing of Services/Entering Claims

https://tmhp.exceedlms.com/student/path/181116-texmedconnect-for-long-term-care-ltc-providers

I recently received this response from HHSC and thought it might be helpful to some providers who may have this concern:

There is no rule or regulation that prohibits an HCS Program Provider from providing services to their own child or family member. You can pop over to this site to get in touch with the best lawyers who will help you to claim this scheme.

The program provider’s operations must prevent conflict of interest as required by 40 TAC §9.177(f):

§9.177 Certification Principles: Staff Member and Service Provider Requirements

(f) The program provider’s operations must prevent:

  (1) conflicts of interest between the program provider, a staff member, or a service provider and an individual, such as the acceptance of payment for goods or services from which the program provider, staff member, or service provider could financially benefit, except payment for room and board;

  (2) financial impropriety toward an individual including:

    (A) unauthorized disclosure of information related to an individual’s finances; and

    (B) the purchase of goods that an individual cannot use with the individual’s funds;

  (3) abuse, neglect, or exploitation of an individual;

  (4) damage to or prevention of an individual’s access to the individual’s possessions; and

  (5) threats of the actions described in paragraphs (2) – (4) of this subsection.

And, the program provider must ensure they are not disqualified from being a service provider as described in Section 3420(b)-(d) of the HCS Billing Requirements:

3420 Service Provider Not Qualified

Revision 21-3; Effective September 1, 2021

(b) Spouse Not Qualified as Service Provider

A service provider is not qualified to provide a service component or subcomponent to the service provider’s spouse.

(c) Relative, Guardian or Managing Conservator Not Qualified as Service Provider for Certain Services

A service provider is not qualified to provide case management, residential support, supervised living, behavioral support services or social work services to an individual if the service provider is:

(1) a relative of the individual (Appendix II, Degree of Consanguinity or Affinity, explains who is considered a relative for purposes of these requirements);

(2) the individual’s guardian; or

(3) the individual’s managing conservator.

(d) Parent, Spouse of Parent or Contractor Not Qualified as Service Provider for Minor

A service provider is not qualified to provide a service component or subcomponent to a minor if the service provider is:

(1) the minor’s parent;

(2) the spouse of the minor’s parent; or

(3) a person contracting with DFPS to provide residential child care to the minor, or is an employee or contractor of such a person.

According to Section 3430 of the HCS Billing Requirements:

3430 Relative, Guardian or Managing Conservator Qualified as Service Provider

Revision 21-1; Effective January 1, 2021

If a relative, guardian or managing conservator is not otherwise disqualified to be a service provider as described in Section 3420, Service Provider Not Qualified, or in Section 4000, Specific Requirements for Service Components Based on Billable Activity, the relative, guardian or managing conservator may provide audiology services, dietary services, occupational therapy, physical therapy, speech and language pathology services, day habilitation, in-home day habilitation, registered nursing, licensed vocational nursing, specialized registered nursing, specialized licensed vocational nursing, transportation as a supported home living activity, host home/companion care, respite, in-home respite, employment assistance or supported employment if the relative, guardian or managing conservator is a qualified service provider for the particular service component or subcomponent being provided.

February 1st, 2022

HCS/TxHmL Writing Acceptable Plans of Correction Webinar

“WHAT IS A POC? 42 CFR §488.401 defines a Plan of Correction to mean a plan developed by the facility and approved by CMS or the survey agency that describes the actions the facility will take to correct deficiencies and specifies the date by which those deficiencies will be corrected.Apr 19, 2021″

Program providers can register for the Writing Acceptable Plans of Correction for HCS and TxHmL webinar. This webinar covers the process for writing an acceptable plan of correction for HCS and TxHmL program providers. No CE is awarded for this webinar. However, a certificate of attendance will be provided.

This will be an ongoing offering posted on the HHCS HCS/TxHmL Joint Training website.

Wednesday, Feb. 9
1 – 4 p.m.
Register for the webinar.

Email questions to Joint Training.

February 1st, 2022

HHSC Publishes Information on Delivery of PT, OT, and ST Services (IL 2022-08)

HHSC is issuing interim guidance allowing telehealth delivery of physical therapy, occupational therapy, and speech therapy services. Access Information Letter No. 2022-08, HB4: Physical Therapy, Occupational Therapy, Speech Therapy Services Delivered by Synchronous Audio-Visual. The letter notes which therapies are not allowed to be delivered through telehealth modalities because the service requires in-person delivery.

This guidance applies to the following programs:

• Community Living Assistance and Support Services Providers
• Deaf-Blind with Multiple Disabilities Providers
• Home and Community-based Services Program Providers
• Texas Home Living Program Providers

Email the LTSS policy mailbox with questions about this alert.

February 1st, 2022

Guidance for LTC Providers

COVID-19 cases continue to increase across Texas. HHSC reminds providers to follow the guidelines listed below and ensure their emergency plan is up to date. Staff must be aware of what to do in the event of any sort of emergency, including an outbreak of flu or COVID-19.

Please review the following rules, guidelines, and policies:

• COVID-19 mitigation and visitation rules for your provider type
• Any applicable COVID-19 response plans for your provider type
• Your organization’s infection prevention and control policies

All provider types must continue to screen residents, clients, staff, and visitors for signs and symptoms of COVID-19.

Staff for all provider types must continue to use appropriate personal protective equipment (PPE).

Where required by rules for your provider type, providers must continue effective cohorting of residents based on COVID-19 status.

Find COVID-19 resources for your provider type online:

• The COVID-19 Resources section of your provider portal
• The HHSC Coronavirus (COVID-19) Provider Information page

Your maintaining vigilance in following infection control requirements makes a difference in protecting vulnerable Texans.

LTC providers are always required to provide services to residents before, during, and after any emergency. Your organization’s emergency plan or policy must include:

• Planning for staff shortages
• Back-up plans to ensure operations and care of residents or clients continues

Read program-specific rules related to staffing, emergency preparedness, and infection control:

• Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions
• Home and Community-based Services
• Texas Home Living

The U.S. Department of Health and Human Services has developed a COVID-19 Healthcare Planning Checklist (PDF) that you can use to assist you in creating a plan for dealing with an outbreak of flu or COVID-19.

For questions, email LTCR Policy.

HHSC has published ICF and HCS Emergency Staffing Requests – Jan. 10

HHSC has published ICF and HCS Emergency Staffing Requests (Provider Letter 2022-02). This letter provides information for Intermediate Care Facilities for Individuals with an Intellectual Disability (ICFs) or Related Conditions and Home and Community-based Services (HCS) program providers facing staffing shortages related to the COVID-19 public health emergency.

January 14th, 2022

January 10th, 2022

When was Omicron Variant First Found in Texas and What is This Variant of COVID-19?  (Please see article below)

Texas Identifies Case of COVID-19 Omicron Variant

HHS  

Corona Virus Testing and Testing Information  (Includes videos and information about finding testing locations near you and home-testing as well)

Booster Shot Information 

DSHS

Below are frequently asked questions (FAQs) about the variants of COVID-19, including the Delta and Omicron variants.

How can I tell if I have the Delta or Omicron variant? Do labs report that to the state?

That information may not be readily available. The viral tests that are used to determine if a person has COVID-19 are not designed to tell you what variant is causing the infection. Identifying COVID-19 variants requires a special type of testing called genomic sequencing. Due to the volume of COVID-19 cases, sequencing is not performed on all viral samples. However, because the Omicron variant now accounts for the majority of COVID-19 cases in the United States, there is a strong likelihood that a positive test result indicates infection with the Omicron variant.

Are the symptoms different for the Delta or Omicron variant? If so, what are they?

Because Delta and Omicron are variants of the same virus—SARS-CoV-2, the virus that causes COVID 19—the symptoms and the emergency warning signs are the same. However, some variants may spread more easily or may cause more severe symptoms and illness. Because of this, scientists are actively monitoring and studying new variants to learn more about how easily they spread, whether they make people more or less sick, and how well they respond to existing vaccines, treatments, and tests.

Is Texas tracking variants of COVID-19?

Yes. Public health officials at the federal, state, and local levels continue to study variants, monitor their spread, develop strategies to slow their spread, and test how variants may respond to existing therapies, vaccines, and testing. For information on variants of concern in Texas, see the Variants and Genomic Surveillance for SARS-CoV-2 in Texas section of the DSHS website.

Who is most at risk of contracting a variant of COVID-19?

Unvaccinated people are most at risk of contracting COVID-19, including any of its variants. The Delta and Omicron variants are more aggressive than other known variants and spread most rapidly in communities with fewer fully vaccinated people.

The absolute best protection for yourself and those close to you is getting fully vaccinated. The vaccine is proven to safely protect you from COVID-19’s worst effects and lowers your chances of spreading the virus. Greatly increasing the number of fully vaccinated Texans is the only way to prevent a devastating rise in the spread of the pandemic virus.

Are the newer variants worse than the early COVID-19 strains? Will a variant make me sicker than previous strains?

Omicron appears to spread much more easily than other known variants, which means it’s more contagious than other variants. We are still learning whether Omicron may put infected people at higher or lower risk of hospitalization than other variants.

What’s the treatment for patients with the Delta or Omicron variant?

There are different treatment options available for all COVID-19 variants, but some treatments may be more effective for certain variants. In many cases, treatments are reserved for certain high-risk groups. If you or a loved one is sick, check with your healthcare provider about your specific case.

What is the current travel guidance?

Travel recommendations may vary depending on whether you are fully vaccinated or not. Some travel destinations may have different requirements for vaccinated and unvaccinated travelers.

Keep in mind that travel and other guidance may change as we learn more about the virus variants and breakthrough cases. Stay up to date with CDC travel recommendations by visiting the Travel page of the CDC website.

Are people of certain ages at higher risk for infection with the newer variants?

Yes. Anyone who is not fully vaccinated is at greater risk of getting COVID-19. Children up to 5 years old are not yet eligible to receive the COVID-19 vaccine. Anyone who is old enough and able to get the vaccine should do so to protect those who are unable to get it, as well as those for whom the vaccine is less protective. That includes children under age 5 and people with certain medical conditions. It’s also important for those people who qualify to get the booster dose, too.

How many known variants are there?

There are many. Because viruses constantly change through mutation, new variants occur all the time. Sometimes they disappear, and sometimes they persist. Variants are classified in four ways, from least to most severe: Variants Being Monitored, Variants of Interest, Variants of Concern, and Variants of High Consequence.

Public health officials are currently studying two that are classified as Variants of Concern: Delta and Omicron. These are variants that show evidence of an increase in transmissibility, more severe disease (increased hospitalizations or deaths), and/or reduced effectiveness of tests, treatments, or vaccines.

In the U.S., there are currently many Variants Being Monitored, but no Variants of Interest or Variants of High Consequence.

To learn more about variants in the U.S., visit the About Variants of the Virus, Variant Classification, and Variant Surveillance pages on the CDC website.

What are the differences between the variants?

Variants vary by their genetic markers. These differences in genetic markers may affect how easily the virus is spread, the severity of illness, how well existing tests can detect the virus, the effectiveness of treatments and vaccines, and more.

Each variant is slightly different. Think of variants like branches on a tree. Each branch is slightly different than others on the tree, but they have similarities, too. Scientists study the differences in COVID-19 variants, so they can label and track them according to those differences.

Do the vaccines protect against the Omicron variant?

Early data suggest that the available vaccines are effective against severe disease and hospitalization caused by the Omicron variant. The best protection against any COVID‑19 variant is getting fully vaccinated. And a booster dose of vaccine is a proven way to maximize the protection against infection and severe disease.

Which vaccine provides better protection against the virus?

In mid-December 2021, CDC updated their vaccine recommendations with a preference for mRNA vaccine (Pfizer and Moderna) over the Johnson & Johnson (J&J) vaccine. However, public health experts continue to say that getting any vaccine is better than being unvaccinated. J&J vaccine will remain available for people who are unable or unwilling to get an mRNA vaccine.

Read CDC’s media statement to learn more about the updated vaccine recommendations.

Keep in mind that guidance may change as we learn more about the virus variants. DSHS will update information as it becomes available.

LTC Regulatory Services

Incident Reporting

HHS regulated providers can self-report incidents affecting resident health/safety, including issues related to COVID-19, online to the Health and Human Services Commission or by calling 1-800-458-9858.

• Incidents Submission Portal for Long-term Care providers
• Incidents Submission Portal for Health Care Quality providers

Intermediate Care Facilities (ICF/IID)

• ICF/IID Provider COVID-19 Vaccination Data Reporting Rule (PDF)
• ICF/IID COVID-19 Expansion of Reopening Visitation Emergency Rule (PDF)
• ICF/IID COVID-19 Response Emergency Rule (PDF)
• COVID-19 Response for ICF/IIDs (PDF)
• Frequently Asked Questions for ICF/IIDs (PDF)

Home and Community-based Services (HCS) and Texas Home Living (TxHmL)

• HCS Visitation Comparison Table (PDF)
• HCS COVID-19 Expanded Visitation Rules (PDF)
• TxHmL COVID-19 Updated Emergency Rules (PDF)
• COVID-19 Response for Home and Community-based Services Residential Providers (PDF)
• Updated COVID-19 FAQs for HCS and TxHmL Providers (PDF)

Revised Guidance on Staff Work Restrictions and Return to Work

HHSC has issued revised guidance for long-term care providers experiencing staffing shortages due to COVID-19. The requirement to contact LTCR before implementing CDC guidance on staff work restrictions and return-to-work has been removed.

“Guidance and Protocol for Long-Term Care Facilities Experiencing Staffing Shortages due to the COVID-19 Public Health Emergency.

This checklist provides guidance for long-term care facilities and residential providers facing staffing shortages related to the COVID-19 public health emergency.

This checklist incorporates CDC guidance with state and federal staffing requirements.

Facilities facing staffing shortages must use this checklist before requesting emergency staffing resources. The CDC’s mitigation strategies are meant to be implemented sequentially (i.e., contingency strategies before crisis strategies). The conventional strategies must be followed when the facility has adequate staffing.

As a reminder, facilities are required to cohort residents based on their COVID-19 status: COVID-19 negative (COVID-negative), COVID-19 positive (COVID-positive), and unknown COVID-19 status (COVID-unknown).1 Healthcare personnel (HCP) are considered “boosted” if they have received all COVID-19 vaccine doses, including a booster dose, as recommended by CDC.”

For more….  Read the updated guidance.

HCS and TxHmL program providers, Local Intellectual and Developmental Disability Authority agencies, and Financial Management Services Agencies billing on behalf of Consumer Directed Services employers can register for webinars starting next month. These webinars will cover information about the Long-Term Care Online Portal and forms that HCS and TxHmL program providers will use.

The webinars will:

• Include a live Q&A session
• Begin in February 2022

Details, including dates, times, and registration links will be in a future article on the Texas Medicaid & Healthcare Partnership website. Providers should check the Recent News section of the LTC webpage often for current information.

HCS and TxHmL program providers, LIDDAs, and FMSAs will begin submitting claims and forms to TMHP on March 1, 2022. Program providers, LIDDAs, and FMSAs should set up the following accounts, if not yet done:

• One of the following for Claims Submission Account:
  • TexMedConnect
  • Electronic Data Interchange
• LTC Online Portal
• TMHP Learning Management System

Failure to set up the necessary accounts can lead to payment delays after March 1, 2022. Program providers, LIDDAs, and FMSAs can find resources for creating the necessary accounts and the time frames it could take to create those accounts linked below.

• TexMedConnect allows users to submit claims and can take up to 10 days. LTC Online Portal allows users to submit, view, and manage forms. Account setup can take up to three days. The TMHP Account Setup for HCS and TxHmL Waiver Programs (PDF) is the available resource.
• EDI allows users to submit claims through a third-party submitter or a provider’s own software. Account setup can take up to 30 days. Access the updated 837P LTC Companion Guide Now Available for HCS and TxHmL Program Claims Submission Practice.
• TMHP LMS allows users access to important TMHP training materials and that takes one day. LMS Registration and Navigation Job Aid for Providers (PDF) is the resource.

Providers can refer to the HCS and TxHmL Waiver Programs Frequently Asked Questions (FAQ) or contact the TMHP EDI Help Desk at 888-863-3638 with questions.

December 20th, 2021

Check LEIE/OIG and check With the implementation of FBI-based fingerprinting in 2021, Long-term Care Regulation (LTCR) also implemented Occupations Code (OC), Chapter 53, related to the consequences of a criminal conviction, specifically the 2019 legislative update to OC §53.023 concerning additional factors for licensing authorities to consider after determining a conviction directly relates to the occupation.

Policy Details & Provider Responsibilities Long-term care facilities and agencies must check and continue to check an applicant’s criminal history, Nurse Aide Registry status, and Employee Misconduct Registry. Use the HHSC Employability Status Search at https://emr.dads.state.tx.us/DadsEMRWeb/ (link is external), which includes information regarding Sanctions. OC § 53 requires an employer to consider only convictions directly related to the occupation.

PL 2021-44 

With this new implementation, it is possible for an individual to receive a license, permit, or certification who is not employable or only employable in limited settings according to Health and Safety Code (HSC) §250.006.

Beginning December 20, 2021, long-term care facilities and agencies must also check the Excel document linked below to determine if an individual is licensed/permitted/certified but is unemployable in one or more long-term care settings licensed by LTCR. This file contains the names of nursing facility administrators, nurse aides, and medication aides that have active licenses/permits/certifications but are unemployable according HSC §250.006 in one or more long-term care settings.

https://www.hhs.texas.gov/sites/default/files/documents/active-unemployable.xlsx

HHS is updating the Employability Search with information on active but employable individuals. Until this update is complete, providers will be required, in addition to checking the Employability Search, to check the Active but unemployable Excel File in the resources section of this Provider Letter.

Resources Active but unemployable Excel File

Contact Information

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

December 17th, 2021

The link doesn’t inform providers about current information but will provide future information about ARPA funds, and will be available on the newly created HHSC Grants webpage.

Press Release: Governor Abbott, HHSC Announce $128 Million To Support Staffing Needs At Rural Hospitals, Nursing Facilities | Office of the Texas Governor | Greg Abbott

According to the HHSC Provider Finance representative- Ms. Ellison at LTCR Dec. 7th meeting with the IDD workgroup, this is the information on how the state-controlled ARPA funds appropriated via SB 8 (3rd Special Session) will be distributed.  [Remember: These funds are separate from the HCBS 10% FMAP funds.]

December 12th, 2021

ISS (Individualized Skills and Socialization)  

Changes to Day Habilitation (DH) programs are coming for HCS/TxHmL!  The link below contains a discussion concerning the implementation of a recommendation in the Rider 21 Report (General Appropriations Act for FY 2020-2021, 86th Session) related to the monitoring of DH programs which will transition to the provision of ISS.

To view, the report go to:  https://www.hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2021/rider-21-transition-day-habilitation-services-jan-2021.pdf

• Current DAHS providers who want to also provide ISS.
• HCS/TxHmL providers operating a DH and serve persons eligible to receive ISS.
• Independent DH providers serving persons eligible to receive ISS.
• ICF/IID providers who operate a DH and only serve persons receiving ICF/IID services will not be required to obtain the license. However, if the ICF/IID provider opens its DH program to serve persons eligible to receive ISS, such as persons enrolled in HCS/TxHmL, it will need to obtain the license.

New & Current HCS/TxHmL Providers, Please Take These Trainings

These are the courses that are really applicable to HCS/TxHmL providers below and they are all free.  Click on them to go directly to these pages:

November 23rd, 2021

 While most of the suspensions related to COVID-19 have ended, the following HCS suspensions are still in place.

• HHSC will still allow an HCS four-person residence to add up to two additional individuals temporarily if the residence has the space to accommodate them and has been approved as a four-person residence by HHSC. (Rule: 40 TAC §9.153(39)(B))
• Suspension of the requirement for HCS providers to ensure at least one complete staff shift change per day for individuals receiving residential support. (Rule: §9.174(a)(38)(C))
• Suspension of the requirement for day habilitation to be provided in accordance with the individual’s person-directed plan, individual plan of care, implementation plan, and Appendix C of the HCS Program waiver application. (Rule: §9.174(a)(28))
• In Relation To a recent alert from HHSC concerning “Background Checks”: 40 TAC 9.177(n) states “The program provider must comply with §49.304 of this title (relating to Background Checks).” This rule has not been waived and is still required.
• Concerning IPC’s & IDRC’s and signatures, I have verified with LTCR (Long-Term Care & Regulatroy) policy department the following:                                                                      The policy letter you will need to reference is  IL 2020-45  and it is currently still valid.

  According to HHSC, a service coordinator or program provider is not required to obtain signatures of the individual or LAR on an IPC renewal/revision or on supporting documentation. However, the program provider or LIDDA service coordinator must obtain an oral agreement from the individual or LAR about the IPC renewal/revision and supporting documentation and document the oral agreement in the individual’s record.  A program provider or LIDDA service coordinator must obtain the signature of a person, other than the individual or LAR, who is required to sign the IPC renewal/revision or supporting documentation.

For more information regarding the End of Temporary Suspension of Certain LTCR Requirements During COVID-19 Outbreak please see Provider Letter 2021-29.

November 10, 2021, HCS, TxHmL, CLASS, DBMD Webinar Recording Available

As some of you may know, Twogether Consulting does not work for Taskmaster Pro, but we do have quite a bit of experience with their software and I love the benefits of this “cloud-based” program.  In the past, I have also used the software for my own HCS program as we had HCS contracts in over 32 counties.  Electronic Records were a must for us with that many counties to keep track of and service providers to monitor!  No matter who you choose to provide those services.  I do, however, highly recommend that if you currently do not have any type of electronic records system that you might want to start thinking about it, especially if you do have lots of area to cover or a large number of individuals in your program.  There are a couple of other programs out there I like and we help providers regardless of what they have chosen to put in place  I am no longer an HCS provider myself, as I am so busy with Twogether Consulting, lol but I certainly enjoy helping our clients using TMP. 

Currently, we do provide quality assurance to providers in Texas and some out of state. Twogether Consulting often provides additional webinars, training, and assistance for providers who are receiving services from TaskMaster Pro software to help them implement their nursing programs more efficiently with TMP’s great tools. We can also assist providers with getting the most out of your TMP software for facility quality assurance. Typically quality assurance plans are quarterly and/or as needed for example.  We provide mentoring for new Case Managers, Q’s, and Nurses, using the TMP software. This can be done off-site and therefore is more cost-effective for the provider.  

November 16th, 2021

Starting August 2021, HHSC has begun the transition to one system for Provider Enrollment Management which will move to 1 “smart system” if you want to become a Medicaid vendor/Medicaid provider, re-enrollment every 5 years, and the forms/application will be uniform.  They will go directly into TMHP system, not to HHSC.  The current paper application forms will not be required.  They have begun the process with existing providers.

One system=PEMS
One NPI-based enrollment
One dynamic smart application (no paper)
One dynamic smart provider agreement
One standardized set of enrollment forms
One provider message board

In Summary:

Providers will be enrolling through PEMS online application, no more paper applications. You will no longer enroll  through HHSC, the application will go directly to TMHP

IDD providers may recall that in 2015 legacy DADS issued a notice that Medicaid providers had to enroll or re-enroll in Medicaid by March 24, 2016, and every 5 years thereafter.  At the time, the process required payment of an application fee that was sent to legacy DADS.   Providers were informed, that as a result, the PHE, revalidation was postponed, and that changes to the process were forthcoming (in particular, that the application process would be completed through a TMHP portal).

Effective February 28, 2022 HHSC is ending the flexibility that extended revalidation dates due during the PHE.

• Providers that were due for revalidation effective March 1, 2020 through February 28, 2022 will be given a post-PHE grace period to complete the revalidation process.  TMHP will notify providers in January 2022 of their recalculated enrollment end date and again 120 days prior to their enrollment end date.
• A webinar to review the process will be held December 7, 2021. See registration link below.
• The system/portal will go live December 13, 2021.

• Link to PHE info: Provider Enrollment Revalidation Extensions to End on February 28, 2022 | TMHP

  Register for the December 7^th webinar: https://www.tmhp.com/news/2021-11-05-register-now-pems-provider-webinar

• Other Resources/Notices:

  https://www.tmhp.com/news/2021-11-05-coming-soon-tmhp-provider-enrollment-and-management-system-pems-0

  https://www.tmhp.com/news/2021-10-29-coming-soon-tmhp-provider-enrollment-and-management-system-pems

  https://www.tmhp.com/news/2021-10-13-coming-soon-tmhp-provider-enrollment-and-management-system-pems

  https://www.tmhp.com/news/2021-09-24-coming-soon-tmhp-provider-enrollment-and-management-system-pems

November 6th, 2021

LTC Providers May Request COVID-19 Emergency Support

For Emergency Staffing Support:

The Office of the Governor directed DSHS to use staffing agencies to provide medical personnel from out-of-state to Texas health care facilities to assist in COVID-19 operations.

This support will be available to residential long-term care providers.

-Providers must demonstrate that they have exhausted all other options.

-Also that they have urgent need for assistance before requesting emergency staffing support.

The State is asking that jurisdictions and health care entities be judicious with requests for staffing, as the State will not be able to address all staffing needs, especially as the need for emergency staffing ramps up across the state.

LTC providers are always required to provide services to residents or clients before, during and after an emergency.

The emergency plan must include:

• Planning for staff shortages
• A back-up plan to ensure operations and care of residents continues

For COVID-19 Vaccination, Testing Kits, PPE, Disinfection, and HAI/EPI Support:

Long-term care providers can request:

• COVID-19 mobile vaccine clinics for residents and staff
• BinaxNow testing kits. Read PL 2020-49 for details.
• PPE (providers should exhaust all other options before request)
• Facility cleaning and disinfection
• Healthcare-associated infection and epidemiological support

To Request Support:

To initiate a request for COVID-19 support described above, contact the HHSC LTCR Regional Director in the region where the facility is located.

HHSC LTCR staff are responsible for initiating a State of Texas Assistance Request on behalf of the long-term care provider.

HHSC LTCR staff may request supporting documentation to verify need.

• Link to Interim Final Rules and FAQs (scroll to bottom of page): https://www.cms.gov/newsroom/press-releases/biden-harris-administration-issues-emergency-regulation-requiring-covid-19-vaccination-health-care
• CMS is hosting national call/webinar Nov. 4th at 2:00 ET:  https://cms.zoomgov.com/webinar/register/WN_7IlEgLznTIm3sqAsv3nHZw

• Link to interim rules:  https://public-inspection.federalregister.gov/2021-23643.pdf
• Link to webinar on YouTube:  https://www.youtube.com/watch?v=ixxkn3Y8z6g&ab_channel=USDepartmentofLabor
• Link to FAQs:  https://www.osha.gov/coronavirus/ets2/faqs

HHSC Publishes Acceptable Documentation for a Criminal History Check for Contractors (IL 2021-48)

HHSC has published IL 2021-48 (PDF).

This letter is provided as a companion letter to PL 2019-01 (PDF) which describes acceptable documentation a contractor may use to demonstrate the contractor conducted a criminal history check of an employment applicant or an employee. Licensed contractors must continue to follow the guidance outlined in PL 2019-01. Unlicensed contractors must follow the guidance in this information letter.

For questions about this information letter, please contact LTSSpolicy@hhs.texas.gov

HHSC Publishes Information to Assist People with Terminated SSI (IL 2021-47)

HHSC has published IL 2021-47 (PDF).

It assists people with terminated Supplemental Security Income. In Texas, people who get Supplemental Security Income benefits are eligible for Medicaid. Under normal circumstances, termination of SSI benefits results in losing Medicaid coverage.  When the continuous Medicaid coverage period ends, these individuals will lose their Medicaid coverage unless their SSI benefits are reinstated they are found eligible for Medicaid under other criteria. If Medicaid coverage ends for an individual enrolled in a waiver program, their waiver program services will also end.

Following the declaration of a federal PHE (public health emergency) on Jan. 27, 2020, federal guidance allows HHSC to maintain Medicaid coverage for people who lose their SSI benefits.

●Applying to have SSI reinstated by the SSA .  ●Applying for Medicaid for the Elderly and People with Disabilities using Form H1200 and Form 1746-A.

Service coordinators and case managers should also encourage individuals to report changes in their circumstances to HHSC, even during the PHE, to ensure contact and eligibility information remains accurate. These changes may include changes of address, phone number, or pregnancy status. Individuals may report changes online at www.yourtexasbenefits.com, by calling 2-1-1, or by contacting a local HHSC benefits office

October 18th, 2021

• Pages 3-24 contain the committee report in bill language.  To view bill language related to the one-time direct care recruitment and retention payments, see Section 33, pages 22-24.
• Pages 25 – 75 reflect the conference committee decisions.  To view decisions specific to retention and recruitment payments, see Section 15, beginning at the bottom of page 45.  The first column reflects the Senate’s version of SB 8; the middle column the House’s version; the last column the conference committee decisions
• Pages 76-77 provide the bill’s fiscal note.

October 3rd, 2021

HHSC Announces HCS and TxHmL Interpretive Guidance Page

HHSC Long-term Care Regulation created the HCS and TxHmL Interpretive Guidance page. This page connects program providers with relevant tools for rule interpretation. It includes the Interpretative Guidance booklet and Certification Principle training.

October 3rd, 2021

Twogether Consulting highly recommends you read through the HCS/TxHmL Interpretive Guidance Booklet and keep this PDF downloaded on your desktop for reference in preparation for survey and for addressing Plans of Corrections after your survey.  This guidance is meant to give you information on what surveyors expect to see when coming to your facility as well as examples of critical vs. non-critical scenarios to help you identify the type of Administrative (monetary) penalties you may incur due to violations (previously citations) made concerning the HCS/TxHmL TAC rules and regs. It is extremely helpful (especially concerning nursing requirements and expectations).

September 30th, 2021

CAP Update: Administrative Penalties for ICFs (PL 21-34)

HHSC published Provider Letter 21-34 Amended Statutory Cap Regarding Administrative Penalties for Intermediate Care Facilities. PL 21-34 notifies providers of changes to how HHSC determines and imposes administrative penalties based on changes made by House Bill 3720 (87th Legislature, Regular Session, 2021).

September 21st, 2021

Updated CDC Guidance for LTC Facilities on Accessing COVID-19 Vaccine – Sept. 2021

The Centers for Disease Control and Prevention has recently updated resources for long-term care facilities on how to help residents and staff access COVID-19 vaccines:

• Vaccine Access in Long-term Care Settings
• Care Administrators and Managers: Options for Coordinating Access to COVID-19 Vaccines
• Jurisdictions Can Ensure COVID-19 Vaccine Access for Staff and Residents in Long-term Care Settings

September 21st, 2021

COVID-19 Vaccine Status Not a Requirement for Services

In accordance with Governor Abbott’s Executive Order No. GA-39, providers must not require clients to provide documentation of their COVID-19 vaccine status as a condition to receive any Texas Medicaid service.

September 15th, 2021

Update: Getting COVID-19 Vaccines-ICF/IID

Nursing, assisted living, and intermediate care facility staff and residents who want to receive the first, second or third dose of the COVID-19 vaccine may use the options below.

Contact the HHSC LTCR Regional Director in the region where the facility is located. Request a mobile vaccination clinic at your facility. The mobile vaccination clinic can administer first, second, or third doses of the COVID-19 vaccine to residents and staff. Facilities may need to make alternate arrangements for staff and residents to receive any more doses after the vaccination clinic.

Enroll as a DSHS COVID-19 Vaccine Provider. Once registration is complete, vaccine providers can request vaccines. Email COVID-19 Vaccination Enrollment or call the DSHS COVID-19 Vaccine Provider hotline at 877-835-7750 with questions. Read the DSHS Vaccine FAQs for more information.

Contact the pharmacy or vaccine supplier. Coordinate directly with your COVID-19 vaccine supplier to schedule vaccine administration for those who want the vaccine.

Use the following to locate vaccines:

• COVID-19 local health entities or DSHS region
• DSHS COVID-19 Vaccine Home page

CMS Adds COVID-19 Vaccination to ICF Rules (QSO-21-21-ICFIID)

August 27th, 2021

The Centers for Medicare and Medicaid Services issued Quality Safety & Oversight Memo QSO-21-21-ICFIID (PDF). The memo announces the addition of COVID-19 vaccine immunization-related requirements. This includes:

• New requirements for educating a person or their representatives as well as staff on the benefits and potential side effects with the COVID-19 vaccine.
• Offering the vaccine.

From DSHS website July 19th, 2021

How to Become a COVID‑19 Vaccinator

. Any facility, organization, or healthcare provider licensed to possess or administer vaccines or provide vaccination services is eligible to enroll through DSHS.

The first step to becoming a COVID‑19 vaccine provider is registering through EnrollTexasIZ.dshs.texas.gov.

Only providers registered through this site can receive and administer COVID‑19 vaccine in Texas.

For questions about registration, please call the DSHS COVID‑19 Vaccine Provider hotline at (877) 835-7750, 8 a.m. to 5 p.m., Monday through Friday or email COVID19VacEnroll@dshs.texas.gov.

Watch a joint video message from TMA President Dr. Fite and DSHS Commissioner Dr. Hellerstedt on COVID‑19 vaccine provider enrollment.

Registration Process 

Each facility or location, including those that are part of a hospital system or clinic network, must register at EnrollTexasIZ.dshs.texas.gov, complete the Centers for Disease Control and Prevention (CDC) COVID‑19 Vaccination Program Provider Agreement and list the healthcare providers at that location that would be responsible for vaccination.

It is recommended to use the Google Chrome internet browser to complete the COVID‑19 Provider Agreement.

For example, each hospital in a hospital system must complete a registration separately and list vaccine providers there.

More information on the CDC requirements is below.

• COVID‑19 Vaccine Provider Frequently Asked Questions
• Patient Population Adjustment Form
• Texas DSHS Immunization Portal Registration Guide
• Tips and Tricks for Enrolling for COVID‑19 Vaccine Program
• Best Practices for Data Loggers
• COVID‑19 Vaccine Management Resources

After Registration

After completing enrollment, you will receive an email confirming your registration. Once approved, you will receive another email confirming your status as a COVID‑19 vaccine provider.

August 15th, 2021

COVID-19 Vaccination Data Reporting Rule:  ICF

HHSC Long-term Care Regulation has published a revised version of the COVID-19 Vaccination Data Reporting Rule (PDF). The rule now includes Emergency Communication System Enrollment for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions.

The rule requires facilities to report COVID-19 vaccination data within 24 hours and enroll in an emergency communication system. HHSC will inform facilities when they can begin enrollment.

The rule became effective Aug. 11.

February 23rd, 2021

IDD Vaccine Plan Approved (HCS/TxHmL/ICF)

February 12th, 2021

HCS/TxHmL:  

Today DSHS reported it has finalized its presentation of the Tarrytown Expocare vaccine plan that the three IDD associations, Tarrytown and DSHS have been working on for many weeks.  DSHS says the plan will be presented to DSHS Vaccine Leadership and the Commissioner today and also the Expert Vaccine Allocation Panel (EVAP) at its next meeting Monday morning.  They expect to present this plan to the Governor’s Office Monday evening at which point DSHS feels it will have a final answer as to whether the plan is approved. Currently, we are not sure when it will be approved.

**This plan was developed using data the three IDD associations obtained from their respective members which include number of vaccines needed in both ICF/IID and HCS/TxHmL programs.  Thank you for all the work our IDD associations do for providers and individuals in the program!)

• HHSC has not made a decision whether this same reporting requirements ICF requires, will be established for the HCS/TxHmL program.

February 12th, 2021                                                                 

ICF/IID:

HHSC will soon release emergency rules and a Provider Letter related to the process it will use to identify which facilities (staff and residents) have already received the vaccine.

A stand-alone webinar on the requirement will also be held.  Here is the link to draft Provider Letter and draft emergency rules 

(So remember to update your policies and procedures for COVID-19 /infection control policies and procedures!!!)

ICF/IID providers will be required to complete a survey indicating how many residents and staff have received the vaccine (1st, 2nd, or both doses).  The survey will be open for at least the duration of the emergency rule, requiring providers to add any new information about the status of the vaccines given  This will allow providers to report 2nd doses given if such was not reflected in a provider’s first data entry (that is provided the individual received a 2-dose vaccine.  Some vaccines will only have 1 dose- i.e. Astrozenica), or to report receipt of newly first-doses given.

After this three week period, HHSC will reconcile the data to identify where gaps exist. This process will include contacting providers as needed to confirm the information reported through the survey.  HHSC anticipates the reconciliation process taking 2 or 3 days.

The data will then be sent to DSHS to be used to link providers still in need of the vaccine (whether 1st or 2nd dose) for the individuals they serve and their staff.  This process will take about 2 weeks.  The full process should take 5 weeks total, assuming HHSC completes its reconciliation process in a timely manner and DSHS is able to link providers to a vaccine entity in a speedy and efficient manner.

• Providers will not be cited on the rule, but it is possible to receive a citation from a desk audit (HHSC did not elaborate on this).
• The survey does not capture (and is not intended to capture) data on individuals who have opted not to receive the vaccine.
• Recognizing that not all providers are aware of or are tracking the vaccination status of their staff, providers only need only to report the number of staff of which they are aware have received the vaccine.

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HHSC has revised the Updated HCS and TxHmL COVID-19 FAQ (PDF)  in response to the revised HCS and TxHmL COVID-19 Mitigation and Visitation rules.

September 21st,2021

COVID-19 Response Plan Revised HCS/TxHmL

COVID-19 Response Plan (PDF) in response to the revised HCS and TxHmL COVID-19 Mitigation and Visitation rules

9/21/21
Updated to reflect changes in response to GA-38 regarding facemasks and updated CDC guidance

The Table of Contents on pages 4 and 5 of the Response Plan will tell you what changes were made, each time the plan was revised, and the date.

February 22nd, 2021

COVID-19 FAQ’s From HHSC for HCS/TxHML

https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/long-term-care/hcs-txhml-general-covid-faq.pdf

January 7th, 2021

Texas Medicaid CHIP COVID-19 Information 

Future meeting notices and information will continue to be shared on these sites, so please check back regularly.

COVID-19 Provider Information

COVID-19 Client Information

December 2, 2020

Reminder: Requirements and Protocol for COVID-19 Emergency Staffing Requests

HHSC LTCR offers emergency staff for facilities facing severe critical shortages. Emergency staffing is only approved for facilities that can’t provide necessary care to residents due to staffing shortages. Emergency staffing is temporary while facilities get alternative staffing resources.

Facilities must have staffing contingency plans in place to address potential staffing shortages due to COVID-19. (42 CFR §483.73(b)(6)).

Facilities are required to have separate staff assigned to each COVID-19 cohort and not share staff between cohorts unless necessary to maintain adequate staffing (40 TAC §19.2802(i)).

Facilities may only request emergency staffing from HHSC if all the following contingency strategies have been exhausted.

• Share staff between unknown COVID-19 status and positive COVID-19 cohorts (see CDC guidance).
• Contact staffing agencies, nearby health care facilities, partners, or local colleges or health care centers to identify supplemental staff. (40 TAC §19.2802(j))
• Identify alternate facilities with adequate staffing to care for residents with COVID-19.
• Note: Nursing facilities must contact their LTCR Regional Director and local health department before using staff who are asymptomatic and have, or may have, COVID-19. This is generally only allowed in emergencies. Implement or attempt all other staffing contingency strategies listed above before this step.

If a facility has implemented or attempted each item listed above and still does not have adequate staff to meet critical staffing levels, the facility must contact the Regional Director for their LTCR Region to request emergency staffing.

If approved for emergency staffing, facilities must submit a transition plan for addressing shortages that includes the following.

• Forecasted timeline for when COVID-19 positive staff will return to work, using the CDC’s Return to Work criteria, and when emergency staff can be released.
• Acquiring temporary staff or recruiting new hires.
• All other strategies for ensuring critical staffing shortages are fulfilled as soon as possible.

December 2, 2020

Risk/Benefit Return to Activity Form (Free from our friends at HRS) 

This could be very helpful for considerations for returning to work, Day Hab, Volunteer Jobs, etc…

https://hrstonline.com/download/risk-benefit-return-to-activity-form/?wpdmdl=3104&refresh=5fc779cf9f80e1606908367

Risk/Benefit Return to Activity Form

Reminder to LTC Facilities about Death Reporting Requirements

July 22, 2020

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

• Intermediate care facilities must report all deaths to Complaint and Incident Intake within one hour. See:
  • PL 17-02 (licensed facilities)
  • PL 17-03 (non-licensed facilities).
• Home and Community-based Services and Texas Home Living Program Providers must report all deaths of people receiving HCS or TxHmL services to HHSC by the end of the next business day following the death or the program provider’s learning of the death. See IL 12-28.

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

LTC Providers Required to Report COVID-19 to HHSC

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

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

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

For FAQ’s For Covid-19

Contact Information For Questions:

• 512-438.5359
  schmidt@hhsc.tx.us.state
• 
  Policy Specialist for HCS/TxHmL
• hcspolicy@hhsc.state.tx.us

Guidance for LTCR Providers on Coronavirus

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

• 888-963-7111
• 877-570-9779

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

From The CDC website:

HHSC and Money Follows the Person Demonstration Grant

Bringing webinar series to health care professionals.

It discusses the work of Dr. Montessori and the Montessori Method when working with older adults with dementia. Dr. Cameron Camp provides this series.

The series will also focus on understanding the application of Montessori principles to improving staff engagement. Discussions includes specific principles and techniques.

Montessori Inspired Lifestyle: Montessori Based Dementia Programming
Sept. 28, 2021
9 a.m. – 4 p.m. CST
Register for the Montessori Based Dementia Programming webinar.

Applying Montessori Principles for Home Care Workers
Oct. 5, 2021
9 a.m. – 4 p.m. CST
Register for the Applying Montessori Principles for Home Care Workers webinar.

Applying Montessori Principles for Leadership and Staff Engagement
Oct. 26, 2021
9 a.m. – 4 p.m. CST
Register for the Applying Montessori Principles for Leadership and Staff Engagement webinar.

Applying Montessori Principles for Families and Loved Ones of Persons with Dementia
Oct. 28, 2021
9 a.m. – 4 p.m. CST
Register for the Applying Montessori Principles for Families and Loved Ones of Persons with Dementia webinar.

This course is for everyone. The focus is on direct care professionals, certified nursing assistants, attendants, social workers, nurses, administrators and activity professionals, recreation therapists, rehabilitation staff and other health care professionals.

HHSC and CHIP Services plans to offer 1.5 continuing education credits to:

• Licensed social workers, marriage and family therapists, psychology professionals and professional counselors
• Certified nurse aides
• Long-term care ombudsmen guardianship
• Assisted living facility managers
• Occupational therapists and assistants
• Qualified intellectual and developmental disability professionals
• Day activity and health services managers and home health and hospice managers

Nurses can receive CEs. CEUS provided by CEU Network have an added fee paid to CEU Network. The information will be provided in class. Other credentialing bodies are still pending.

CMDCP Certified Montessori Dementia Care Professional Certification:

Participants can apply for the Montessori certification, CMDCP Certified Montessori Dementia Care Professional with ICCDP, after attending one of the above seminars. The discounted price for the CMDCP application is $35 versus $135. Applications must be completed online within 30 days of completing the seminar. Visit www.iccdp.net or contact the International Council of Certified Dementia Practitioners at iccdpcorporate@iccdp.net for information about CMDCP Certified Montessori Dementia Care Professional certification. Obtain the handout as part of the webinar. It explains the steps to apply online and receive the discount.

Visit cen4ard.com for information about the courses.

HHSC Publishes Guidance for Ending of the Temporary Suspension of Certain LTCR Requirements During COVID-19 Outbreak (PL 2021-29)

Updated September 15th, 2021  (Originally posted on August 15th, 2021)

HHSC has published Provider Letter 2021-29 (replaces PL 2020-21 and 2020-26) – End of Temporary Suspension of Certain LTCR Requirements During COVID-19 Outbreak (PDF).

The letter describes the rule suspensions that ended, the rule suspensions that are still in place, and the rule suspensions that will be ended in the future.

See below specifics for HCS & ICF Only  (link above takes you to guidance for all LTC types of providers)

Suspension of Therapeutic Leave ends August 4th, 2021

• ICF/IID:
• Therapeutic Leave. (Rule: 26 TAC §261.226(a)-(f)); Statute: HSC §252.203(2))

The suspension of license application and renewal timeline requirements ends on October 3, 2021.

ICF/IID:
• Rules: 26 TAC §551.15(a), (d), and (e) and §551.21(a), (c), and (e)

The following rules will no longer be suspended effective November 2, 2021:-Fire Marshall Approval Documentation

ICF/IID: 26 TAC §551.12(a)

Suspensions Still in Place

• HCS:
• Updated September 15th– HHSC will now allow an HCS four-person residence to add an additional 2 individuals temporarily if the residence has the space to accommodate and has been approved as a four-person residence by HHSC. (Rule: 40 TAC §9.153(39)(B))

•The program provider must notify HCS Survey Operations of the additional individual(s) by emailing the following information to WaiverSurvey.Certification@hhsc.state.tx.us.

•Provider Name and Contract Number

•Name and CARE ID of the individual moving

•Location code and address of permanent residence•Location code and address of temporary residence

Other Suspensions for HCS In place.

• Suspension of the requirement for HCS providers to ensure at least one complete staff shift change per day for individuals receiving residential support. (Rule: §9.174(a)(38)(C))

• Suspension of the requirement for day habilitation to be provided in accordance with the individual’s person-directed plan, individual plan of care, implementation plan, and Appendix C of the HCS Program waiver application. (Rule: §9.174(a)(28))

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

September 5th, 2021

HHSC Publishes In-Home Day Habilitation Information for Program Providers for COVID-19 (IL 2021-39)

The Texas HHSC is temporarily waiving certain requirements in Section 3710, 4381.3, 4381.7(6) and 4381.7(7) of the Home and Community-based Services Billing Guidelines and the Texas Home Living Billing Guidelines.

This is in response to COVID-19 and to provide access to needed day habilitation services.

HHSC has published a revision to this guidance, IL 2021-39 In-Home Day Habilitation Information for Program Providers for COVID-19 (PDF), replacing IL 2021-33.

It extends the temporary guidance through September 30, 2021.

Email questions to HCSPolicy@hhsc.state.tx.us

May 3rd, 2021

HHSC Publishes In-Home Day Habilitation Information for Program Providers for COVID-19 (IL 2021-20)

The Texas HHSC is temporarily waiving certain requirements in Section 3710, 4381.3, 4381.7(6) and 4381.7(7) of the Home and Community-based Services Billing Guidelines and the Texas Home Living Billing Guidelines.

This is in response to COVID-19 and to provide access to needed day habilitation services.

HHSC has published a revision to this guidance IL 2021-20 In-Home Day Habilitation Information for Program Providers for COVID-19 (PDF) which replaces IL 2021-16. It extends the temporary guidance through
May 31, 2021.

Email questions to HCS Policy.

April 17th, 2021

Revisions to Guidance For Day Habilitation Providers Coming!

HHSC and DSHS are working on revisions to the DSHS Guidance for DHs.  Once revisions are finalized HHSC will notify providers.

March 25th, 2021

Program Provider Response to COVID-19 and Visitation Expansion-

Day Habilitation Off-Site

2.1.8 Day Habilitation and Outside Employment
Individuals receiving HCS or TxHmL services can choose to attend off-site day habilitation that is in compliance with DSHS Checklist for Day Habilitation Sites or outside employment with documented informed decision-making.
• The program provider’s infection control policy must include provisions specific to those attending off-site day habilitation, employment, or any other community activity to ensure the health and safety of individuals.
• The program provider must screen individuals for fever and other signs and symptoms of COVID-19 upon their return to the residence.
• If program provider staff does not provide transportation, the program provider should arrange for pick-up and drop-off to occur outside the residence when possible. If transportation staff must enter the residence to prepare individuals for transportation, they must be screened and wearing a face mask.
• Program providers must provide oversight of day habilitation settings to ensure compliance with their contract. They must request documentation (e.g., policies, plans, procedures) from the day habilitation site that demonstrates how it plans to comply with DSHS guidance. For outside employment, the program provider must request from the employer information on how the employer is responding to COVID-19 to protect its employees.
PL 21-09 March 25, 2021 Page 5 of 20

• The program provider must ensure individuals are supplied with masks or cloth face coverings and encourage their appropriate use, unless contraindicated. The provider cannot charge individuals for facemasks or face coverings.
Providers are responsible for ensuring the health and safety of the individuals in their care. In the context of deciding whether to attend outside day habilitation sites, the program provider fulfills this responsibility by participating in the informed decision-making process, which includes:
• Providing a full list of available options and alternatives, including in-home day habilitation, if available;
• Assessing the risks of attending day habilitation;
• Providing training on PPE, hygiene, and physical distancing;
• Except for individuals in host-home and own home/family home settings, ensuring that individuals have access to PPE.
For individuals in a host home and own home/family home settings, the program provider must encourage individuals to wear a facemask or face covering over the nose and mouth and use any other required PPE necessary to safely attend the day habilitation site.
The program provider must only contract with a day habilitation site that agrees to comply with DSHS guidance. As part of its contractual oversight of the day habilitation site, the HCS or TxHmL program provider should set up a system to monitor compliance with DSHS guidance.
In addition, the program provider must include in its contract a requirement for the day habilitation site to inform individuals, program providers, staff, and family when it is aware of probable or confirmed cases of COVID-19 among staff or the individuals it serves. However, a day habilitation site must not release personally-identifying information regarding confirmed or probable cases.

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.

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The Informal Dispute Resolution (IDR) process gives nursing facilities, assisted living facilities, intermediate care facilities, Home and Community-based Service and Texas Home Living waiver providers the opportunity to informally dispute regulatory survey findings. (Texas Government Code §531.058 and Human Resources Code §161.0892).

In accordance with Senate Bill 304, 84th Texas Legislature, 2015, and House Bill 2590, 85th Legislature, 2017, the Texas Health and Human Services Commission has contracted with Michigan Peer Review Organization (MPRO) to perform IDR reviews and make a recommendation of compliance or non-compliance.

To request an IDR, facilities must submit via email a fully executed IDR Request Form to the HHSC IDR Department within 10 calendar days of receiving the official Statement of Deficiencies (Forms 2567/3724) or Final Report. If a timely request is made for an IDR, HHSC will forward the request to MPRO. Facilities/providers are then required to submit a rebuttal letter and supporting documentation directly to MPRO within the required timeframes.

Request Forms

• IDR Request Form for NFs, ALFs, and ICFs (PDF)

Due Dates

Supporting documentation due dates are as follows:

• For NFs, ICF and the HCS/TxHML waiver providers the due date is the 5th calendar day after submitting the IDR Request form to HHSC on time.

Note: If the due date falls on a Saturday, Sunday or legal holiday, the due date becomes the next business day.

Where to Submit Your Supporting Documentation

All rebuttal information may be submitted via MPROs IDR Secure Application. Find instructions and link at www.mpro.org/texas-idr, or by mail to the address below:

MPRO – IDR Department
22670 Haggerty Road, Suite 100
Farmington Hills, MI 48335
www.mpro.org/texas-idr

For questions or problems with submitting supporting documentation, contact MPRO:

Aris Rhodes-Bond, IDR Project Specialist
248-465-7405

Charlene Kawchak-Belitsky, IDR Senior Manager
248-465-1038

Email: iidrgroup@mpro.org

Texas Administrative Code rules for IDR

• SNFs/NFs and ICF/IIDs

For questions or problems with submitting the IDR Request Form, contact IDR:

HHSC IDR Department
IDR@hhsc.state.tx.us
512-706-7268

September 1st, 2021

The Health and Human Services Commission created the Regulatory Services Division (RSD) in 2017 as regulatory functions consolidated from the Department of Family and Protective Services (DFPS), the Department of Aging and Disability Services (DADS), and the Department of State Health Services (DSHS). As part of this consolidation effort, new teams were developed while keeping the division’s core values of quality, consistency, efficiency, and accountability in mind. RSD LTCR continues to move forward with transformational activities and the next phase includes the integration of the Waiver Survey and Certification Unit into Survey Operations and regional structure. This transition occurred as of August 30, 2021.  Revisions have been made as part of this process to reflect changes on how to file a complaint regarding an HCS or TxHmL surveyor.

Requests For Exceeding Licensed Capacity During Severe Gulf Coast Weather

HHSC Long-term Care Regulation is reminding providers to be ready to implement emergency preparedness plans. If your facility is impacted by severe weather such as wind or flooding, or is in an area under mandatory evacuation orders, contact the HHSC LTCR Regional Director in the region where the facility is located.

In addition to contacting the HHSC LTCR RD, all requests to exceed licensed capacity due to an emergency must be approved by the director of survey operations. If your facility is projected to exceed its licensed capacity because it is accepting residents who have been evacuated from another facility, email Renee Blanch-Haley and include State Capacity Increase Request in the subject line.

If you have any questions, contact your HHSC LTCR RD, email LTCR Policy and Rules or call 512-438-3161.

August 26, 2021

Assisted living facilities, nursing facilities, and intermediate care facilities for people with intellectual disabilities are only required to report COVID-19 cases in residents or staff to HHSC if:

1. It is the facility’s first ever COVID-19 case
2. It is the facility’s first case after having had no COVID-19 cases among staff or residents for 14 days or longer

Read Provider Letter 2021-04 (PDF).

Email questions to LTCR Policy for more information, including a decision tree on when to report.

August 25th, 2021

Program Provider Response to COVID-19 and Visitation Expansion for HCS

(PL 2021-30)

HHSC published Provider Letter 2021-30 Program Provider Response to COVID-19 and Visitation Expansion for HCS. This letter replaces PL 2021-09.  This letter describes the actions a program provider must take to mitigate COVID-19 according to Executive Order GA-38(link is external) and CDC guidance and the criteria for expanded indoor and outdoor visitation as well as essential caregiver visits.

As part of the continued reopening of the State of Texas, the Texas Health and Human Services Commission (HHSC) has published new Home and Community-based Services (HCS) Program Provider Response to COVID-19 Emergency Rule1 and HCS Expansion of Reopening Visitation Rule2.

HCS Program Provider Response to COVID-19 Emergency Rule HHSC published new HCS Program Provider Response to COVID-19 – Mitigation Rules effective August 21, 2021. These new rules replace the previous COVID-19 mitigation rules. See the HCS Program Provider Response to COVID-19 Emergency Rule at 40 TAC 9.198 for the complete list of requirements. Notable updates include the following.

HHSC added the definition for a “fully vaccinated person,” which is a person who received the second dose in a two-dose series or a single dose of a one-dose COVID-19 vaccine and 14 days have passed since this dose was received

(PL 2021-09) on Visitation Expansion

(This letter was published March 25th, 2021)

(PL 2021-09) on Visitation Expansion is no longer in place as of August 2021.  It replaced the following Provider Letters:   PLs 2020-22 and 2020-40

September 21st, 2020

An ICF resident, as well as an individual living in an HCS group home, may have up to 2 Essential caregivers, as defined in the emergency rules, and they must have a negative COVID-19 test result from a test performed no more than 14 days before the first essential caregiver visit unless the facility chooses to perform a rapid test prior to entry into the facility.  Providers are still seeking clarification for some of the new COVID-19 emergency mitigation rules (including visitation rules) for persons receiving HH/CC services.  We plan to keep you updated!

Expanded ReopeningVisitation:

Phase 1 requirements all remain in place (except for compassionate care visits, which are being replaced with less restrictive essential caregiver visits.)

All facilities without an active facility acquired outbreak can move to visitation as outlined in the emergency rules(including those with isolation wings), but visitation is only allowed for residents/individuals,  who are NOT COVID positive and in areas away from COVID positive isolation areas.

Essential caregivers will be trained by the facility on PPE use and infection control, and they must meet the testing requirement.

Reopening is optional for facilities; those that do not feel they have the resources to re-open safely will not be mandated to open or allow for essential caregivers.

See the link below for more information on Visitation Rules for LTC Facilities, including ICF and HCS

https://hhs.texas.gov/sites/default/files/documents/services/health/coronavirus-covid-19/reopening-visitation-ltc-facilities.pdf 

August 15th, 2021

HHSC Publishes HCS and TxHmL Survey Operations Transformation (PL 2021-26)

In advance of the HCS Waiver Survey and Certification unit’s transition to Long-term Care Survey Operations, HHSC has published PL 2021-26, HCS and TxHmL Survey Operations Transformation (PDF). The letter provides information about HHSC’s transformation efforts and what HCS and TxHmL program providers can expect on August 30, 2021.

August 1st, 2021

Information Letter No. 21-32 –Requirements for IPC Submissions for Individuals Requesting Services Funded with General Revenue

This information letter describes the documentation that a CLASS case manager, DBMD program provider, HCS service coordinator, or HCS program provider must submit to HHSC to request the use of general revenue to pay for services above the individual cost limit of a waiver program.

To justify a request to use general revenue when an individual is enrolling in the CLASS, DBMD, or HCS Program or when an individual’s individual plan of care (IPC) is being revised or renewed:
● The individual’s IPC must be electronically transmitted to HHSC using the HHSC Data System.
● The following additional documentation must be submitted to HHSC through the HHSC portal, or by email or regular mail:

 An IPC that is identical to the electronically transmitted IPC and contains all required signatures of the service planning team
 For an individual in the HCS Program, the person-directed plan and implementation plans for all services included on the IPC
 For an individual in the CLASS or DBMD Program, the individual program plan

 A current comprehensive nursing assessment by a registered nurse who is employed by or contracts with the CLASS direct services agency, or the HCS or DBMD program provider
 Physician orders used by the registered nurse to develop the IPC
 If a home and community support services agency will provide the nursing on the IPC, CMS form 485, Home Health Certification and Plan of Care
 If a nurse employed by or contracting with an HCS program provider will provide the nursing on the IPC, documentation containing the same information as CMS form 485, signed by a physician
 Nursing notes from the two-week period immediately preceding submission of the documentation
 Medication administration record sheets from the two-month period immediately preceding submission of the documentation
 Records, notes, and orders of a primary care or specialty physician that are relevant to the services on the IPC, including office visit notes documenting the individual’s current medical conditions. Preprinted after-visit instructions and office notes from a nurse, nurse practitioner, or physician assistant do not meet this requirement. Office visit notes must be dated within the 12-month period immediately preceding submission of the documentation.

The following additional documentation, if relevant, may be submitted to HHSC to justify a request to use general revenue when an individual is enrolling in the CLASS, DBMD, or HCS Program or when an individual’s IPC is being revised or renewed:
● Records related to an individual’s health, such as blood sugar levels, bowel movements, seizures, and suctioning
● Hospitalization paperwork and discharge notes from the one-year period immediately preceding the submission of documentation

● Documentation to support unusual or new diagnoses, such as a comatose or vegetative state
● Hospice assessment, if applicable
● Community First Choice Personal Assistance Services/Habilitation Assessment form
● Evidence of a determination of whether to delegate health maintenance activities, as defined in 22 TAC §225.4, and, if delegated, documentation of delegation monitoring, such as nursing notes describing monitoring or training of unlicensed staff

A CLASS case manager, DBMD program provider, HCS service coordinator, or HCS program provider must respond to a request from HHSC for additional information.
When an IPC is being renewed, the documentation described in this letter must be submitted 30-60 days before the effective date of the renewal IPC.
HHSC does not authorize an IPC for which general revenue is requested until a review of the documentation described in this letter is completed by HHSC.

If you have any questions about submitting a request to use general revenue to pay for services above the individual cost limit of a waiver program, please call Utilization Review at:   (512) 438-5055.

Update to COVID-19 Guidance for Service Coordinators

Fee-for-service Medicaid 1915(c) waiver case managers and service coordinators may use telehealth or the phone to conduct service coordination visits. This temporary policy change extends through Aug. 31, 2021.

SC’s are encouraged to complete visits by phone, telehealth or telemedicine.
Program providers must complete the required background checks for all service providers. They must follow:

• The Texas Administrative Code, Title 40, Part 1, Subchapter D and N
• HCS and TxHmL Rules,§9.177 (n) and (o), and §9.579 (r) and (s)
• HCS and TxHmL Billing Guidelines (PDF) Section 3400 for service provider qualifications

July 17th, 2021

Texas Medicaid 1115 Transformation Waiver Extension

HHSC announces its submission of an extension application to the Centers for Medicare & Medicaid Services (CMS) for the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver under section 1115 of the Social Security Act.

The extension request is for approximately 10 years, which will provide the 1115 waiver authority through 2030. The extension reflects the same terms and conditions agreed to and approved by CMS on Jan. 15, 2021.

The requested extension will allow Texas continued flexibility to pursue the goals of the existing 1115 waiver:

• Expand risk-based managed care to new populations and services.
• Support the development and maintenance of a coordinated care delivery system.
• Improve outcomes while containing cost growth.
• Transition to quality-based payment systems for managed care and providers.

Stakeholders may take part in a meeting regarding the waiver application next Tuesday:

July 20, 2021

11 a.m. Central time

Register for the webinar.

Stakeholders may review the final application posted here.

The American Rescue Plan Act (ARPA) of 2021 was signed into law on March 11, 2021. Section 9817 of ARPA provides states with a temporary ten (10) percentage point increase to the federal medical assistance percentage (FMAP) for Medicaid Home and Community-Based Services (HCBS), if certain federal requirements are met. States must use funds equivalent to the amount of federal funds attributable to the increased FMAP to implement activities that enhance or strengthen Medicaid HCBS. The Health and Human Services Commission (HHSC) submitted an initial spending plan to the Centers for Medicare and Medicaid Services (CMS) on July 12, 2021.

The plan Texas submitted is contingent upon federal clarification on outstanding questions.vTexas proposes to use state general revenue to fund projects to:

• Support providers of HCBS and community-based long-term services and supports (LTSS);
• Support recipients in HCBS programs; and
• Enhance and strengthen the HCBS infrastructure in Texas.

Please join HHSC on Thursday, July 15 at 10:00 a.m. for a webinar with stakeholders. HHSC staff will provide information about the contents of the plan, next steps, and answer stakeholder questions. Register here to join the webinar(link is external).

Read the ARPA HCS Funding Plan (PDF).

Stakeholder Comments Requested for HCS, TxHmL Billing Guidelines, As Well As Proposed Billing Requirements, Provider Fiscal Compliance and TMHP Revisions

HCS and TxHmL Stakeholders can now comment to the HCS, TxHmL and CFC Billing Guidelines by July 18, 2021 about the proposed revisions:

• Proposed Billing Requirements
• Provider Fiscal Compliance
• TMHP revisions

The proposed billing guidelines revisions and a summary of changes were posted on June 18, 2021. They are located on the Long-term Care Providers page and are outlined below:

HCS

• Billing Guidelines (PDF)
• Summary of Billing Guidelines (PDF)

TxHmL

• Billing Guidelines (PDF)
• Summary of Billing Guidelines (PDF)

July 2nd, 2021

HHSC selected the Bexar service area as the primary service area in which to operate the STAR+PLUS Pilot Program

Yesterday members of the IDD SRAC and STAR+PLUS Pilot Program Workgroup were sent the notice below regarding selection of the STAR+PLUS Pilot site.   As the result of HB 4533 (Klick – 86th Session) Chapter 534, Government Code was amended and, among other changes, directs the pilot to assist in evaluating and developing a plan for the transition of all or some of the long term services and supports currently provided through the non-residential  services provided through the HCS, TxHmL, CLASS and DBMD waiver programs.  Chapter 534, Government Code calls for the pilot to start  9-1-2023 and conclude on 9-1-2025.

Notes:  i)  Prior to consideration of the transition of the residential services provided through the community-based ICF/IID program and the HCS and DBMD waivers, Chapter 534 calls for a separate pilot.  ii)  It is not known at this time how the STAR+PLUS procurement process will impact the number of and current MCOs in the Bexar STAR+PLUS service area.   The procurement is expected to be released in Q2 of FY 2022 with awards to be announced in Q3 of FY 2023 and an operational start date of Q1 of FY 2024.

Message to Members of the IDD SRAC and the STAR+PLUS Pilot program Workgroup:  Texas Government Code, Section 534.106(c) states the pilot program shall be conducted in a STAR+PLUS Medicaid managed care service area selected by the Health and Human Services Commission (HHSC).

HHSC has also identified two backup service areas if unforeseen circumstances prevent operation in the Bexar service area that are prioritized in the following order:

1.   MRSA Northeast

2.   Tarrant.

This link shows the Medicaid managed care service areas.

July 3rd, 2021

Updates to HHSC EVV Mailboxes and Website

HHSC EVV Mailboxes

By June 28, HHSC EVV Operations will update their electronic mailboxes to the following email addresses:

• HHSC Electronic Visit Verification Mailbox: EVV@hhs.texas.gov
  • Previous email address: Electronic_Visit_Verification@hhsc.state.tx.us
• HHSC EVV Proprietary Systems Mailbox: EVVPSO@hhs.texas.gov
  • Previous email address: EVV_PSO@hhs.texas.gov

Additional Information

• Assess all personal materials, such as contact matrices, for any updates needed.
• Always refer to the HHSC EVV website for current information and resources.
• HHSC EVV Operations will continue receiving emails if a previous email address is used.

HHSC EVV Website

Throughout June and July, the HHSC EVV website and some of its webpages will have a new layout to reorganize resources and include updates related to the 21^st Century Cures Act, Section 12006.

Email the HHSC EVV Mailbox with any related inquiries.

February 7th, 2021

Electronic Visit Verification (EVV) Contact Information

For questions about Claims, providers should call the TMHP EDI Helpdesk at: 888-863-3638,
Option 4, including questions about:
•
Electronic Data Interchange (EDI) – Submitting Claims for EVV.
•
Claim Rejections (excluding Long-Term Care [LTC] claim rejections with error code F, RJ, and/or AC).

For questions about EVV Claims Processing, contact the entity that pays or denies your claims

(i.e., the managed care organization [MCO]. There is a list of MCO phone numbers at the end of this post).

For questions about EVV Claims Processing that are specific to TMHP call:
•
LTC: 800-626-4117, Option 1, then Option 6.
•
Acute Care: 800-925-9126, Option 7.

For EVV general complaints questions, contact:
•
HHSC Program Providers email: Electronic_Visit_Verification@hhsc.state.tx.us.
•
MCO Program Providers at your MCO’s EVV mailbox (listed at end of this post)

For questions about MCO complaints, email: HHSC Managed Care Compliance and Operations at:
HPM_Complaints@hhsc.state.tx.us.

For questions about EVV Vendor complaints, email the TMHP EVV mailbox at: EVV@tmhp.com.

If you have questions about policy and compliance, contact:
email the HHSC EVV Operations mailbox at: Electronic_Visit_Verification@hhsc.state.tx.us.

Questions may include:
•
Rules.
•
Programs and Services Required to Use EVV.
•
The 21st Century Cures Act.

For general questions about EVV policy and compliance reviews, contact HHSC Program Providers at: Electronic_Visit_Verification@hhsc.state.tx.us

or

the MCO Program Providers at your MCO’s EVV mailbox (See page 18 for a list of email addresses).

Questions may include:
•
Allowable Phone Identification and Recoupment.
•
Compliance Oversight.
•
Reason Codes.
•
EVV Usage.
•
Policy and Requirements.
•
EVV Reports and Understanding EVV Reports.
•
Visit Maintenance and Unlock Request Policy.
•
Reason Codes.

For questions about the EVV Portal, email the TMHP EVV mailbox at
EVV@tmhp.com

or

contact the EVV Vendor (See EVV Vendor list at the end of this post).

Questions may include:
•
General Support.
•
EVV Provider Onboarding.
•
EVV Reports in the Vendor System.
•
EVV Visit Transactions – Includes Accepted and/or Rejected EVV Visit Transactions.

For questions about TexMedConnect and Electronic Data Interchange call the TMHP EDI Helpdesk at: 888-863-3638, Option 4.

Questions may include:
•
File Submission Errors.

•
Form Processing (i.e., EDI Agreement, TPA, and TPAEF).
•
PIMS Assistance.
•
Submitter IDs – Creation and Modification.
•
TexMedConnect and EDI – Account Setup, Submitting Claims for EVV.

For questions about training on the EVV Vendor System, contact the EVV Vendor (See EVV Vendor list at the end of this post).

Questions may include:
•
General questions.
•
Accessing Reports.
•
EVV Clock In and Clock Out Methods.
•
Making Corrections through Visit Maintenance.

For questions about TMHP Systems training, email questions to the TMHP EVV mailbox at:EVV@tmhp.com.
Note: For non-system-related EVV Policy questions email the HHSC Program Providers at:Electronic_Visit_Verification@hhsc.state.tx.us

or

the MCO Program Providers at your MCO’s EVV mailbox (See below for a list of email addresses).

Questions may include:
•
EVV Portal and EVV Standard Reports.
•
Claims submission.

EVV Vendor list

DataLogic Software, Inc./Vesta:
Phone: 844-880-2400
Email: info@vestaevv.com

First Data Government Solutions/AuthentiCare:
Phone: 877-829-2002
Email: AuthenticareTXSupport@firstdata.com

MCO EVV Contact Information/Contact Information for MCOs

Aetna
844-787-5437
evvmailbox@aetna.com

Amerigroup
800-454-3730
TXEVVSupport@amerigroup.com

Blue Cross Blue Shield
877-784-6802
BCBSTX_EVV_Questions@bcbstx.com

Children’s Medical Center Health Plan
800-947-4969
cmchpevv@childrens.com

Cigna-Health Spring
877-653-0331
providerrelationscentral@healthspring.com

Community First Health
855-607-7827
cfhpevv@cfhp.com

Cook Children’s Health Plan
800-964-2247
CCHPEVV@cookchildrens.org

Driscoll Children’s Health Plan
877-324-7543
evvquestions@dchstx.org

Molina Healthcare of Texas
866-449-6849
mhtxevv@molinahealthcare.com

Superior Health Plan
877-391-5921
SHP.EVV@superiorhealthplan.com

Texas Children’s Health Plan
800-731-8527
EVVGroup@texaschildrens.org

United Health Group
888-887-9003
uhc_evv@uhc.com

Turn of Events:  Good News For Providers

• Calls for an ICF/IID representative on the HHSC LTC Facilities Council,
• Caps the amount/$ of administrative penalties which may be imposed per each ICF/IID on-site regulatory visit or complaint investigation,
• Requires HHSC not to enforce an administrative penalty in the HCS or TxHmL waiver programs until interpretive guidelines are developed and adopted, and
• Requires that rules to implement the changes required by HB 3240 be adopted not later than December 1, 2021.

May 25th, 2021

The Federal Communications Commission is offering an Emergency Broadband Benefit.

This new benefit will:

• Help families and households struggling to afford Internet service during the COVID-19 pandemic.
• Connect eligible households to jobs, critical health care services, virtual classrooms and more.

Read information about the benefit and eligibility requirements here.

The University of North Texas Workplace Inclusion & Sustainable Employment (UNTWISE) is offering a free on-demand, prerecorded webinar called Ethics of Informed Choice, which is available through April 22, 2022. This training outlines informed choice and helps contractors, vendors, and Vocational Rehabilitation (VR) staff understand its importance in the VR process. Information on the training can be found on the UNTWISE web page.

“This training will define Informed Choice and help contracted providers and VR staff understand its importance in the VR process.  Laws related to informed choice as well as results from the Rehabilitation Council of Texas annual report will be discussed.  Best Practices, Ethics of Informed Choice, and Case Studies will be used to outline the role of VR staff and providers.”

Presenter: Lucy Gafford

May 16th, 2021

For those of you wanting a separate copy of the ANE TAC principles that were put into the HCS TAC in October of 2019, I have attached links to a few pdf versions for you to use at your facility.  These particular set of HCS principles are important to keep handy, especially concerning follow-up timelines as well as who to contact, when to contact and report and what to report. after an allegation.  

40 Tex. Admin. Code § 9.175
Certification Principles: Requirements Related to the Abuse, Neglect, and Exploitation of an Individual

or

HCS ANE Principles

Attention: HCS, TxHmL, CDS, CLASS, DBMD, ICF/IID, SNF’s, and other HHSC programs

Providers can sign up to receive Gov Delivery, an electronic mailer from HHSC that includes current news and topics of interest for LTC providers.

Twogether Consulting Social Media pages.

Facebook page:   https://www.facebook.com/TwogetherConsultingIDDWaiverConsultants

Instagram Page:   https://www.instagram.com/twogetherconsulting/

May 3rd, 2021

Information Letter No. 2021-19

Termination of Waiver Services during the Public Health Emergency was on hold for eligibility issues, but that is now back in effect as of May 10th, 2021.

This information letter is to notify you that, starting May 10, 2021, HHSC will resume ending waiver services of an individual who is not eligible for CLASS, DBMD, HCS, or TxHmL. This is being done in accordance with a rule promulgated by the federal Centers for Medicare and Medicaid Services (CMS).
During the federal public health emergency (PHE), HHSC has not terminated individuals’ IDD waiver services for most reasons related to eligibility. The only service terminations processed during the PHE have been due to an individual dying, moving out of state, or voluntarily withdrawing from a program.
In accordance with CMS’s Interim Final Rule CMS-9912-IFC, starting May 10, 2021, HHSC will resume processing CLASS, DBMD, HCS, and TxHmL program terminations for individuals who do not meet a program’s eligibility. The rules for program eligibility are:
● §9.155 for HCS,
● §9.556 for TxHmL,
● §42.201 for DBMD, and
● §45.201 for CLASS.
Individuals no longer eligible for a waiver program will have waiver services terminated, but may continue to receive Medicaid state plan services, such as primary care and pharmacy benefits, until the end of the federal PHE.
If there are any additional changes to Medicaid coverage, HHSC will notify individuals at the appropriate time.

To read more, here is Information Letter 2021-19

Contact the following with questions about termination of a person’s program:

HCS, TxHmL, CLASS Program Services:
IDD Program Enrollment and Support Message Line at 512-438-2484.

DBMD Program Services
IDD Utilization Review Message Line at 512-438-4896

• Table of Contents:      Page 1
• Rule Introduction (purpose, applications, definitions):      Pages 2 – 7
• ALFs:            Pages 8 – 11
• DAHS:           Pages 12 – 15
• HCSSAs:       Pages 16-24
• Prescribed Pediatric Extended Care Centers:    Pages 25 – 27
• Nursing Homes:             Pages 28-37
• ICFs/IID:                  Pages 38 – 41
• HCS:                        Pages 42 – 45
• TxHmL:                   Pages 46 – 47

April 17th, 2021

HCS Retainer Payments Status

We have been informed that CMS has finally approved retainer payments for HCS.  Certain provider associations will have the opportunity to review and provide feedback on the draft Information Letter related to the payments.  HHSC is also developing rules related to this initiative, but those associations will not be able to provide feedback on them.   HHSC  will conduct a webinar on the HCS retainer payments.

MEDICAID WAIVER PROGRAM WEB-BASED TRAINING FROM HHSC

Abuse Neglect and Exploitation Competency Training and Exam     

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

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

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

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

March 16th, 2021

March 4 Recording of Writing Acceptable Plans of Correction Webinar Available

A recording of the March 4, 2021 Writing Acceptable Plans of Correction webinar for HCS and TxHmL program providers is available for those unable to attend.

Listen to the webinar recording here.

December 11, 2020

Plan of Removal

Plan of Removal 

This course provides a reference guide for a plan of removal and shows how such a plan differs from a plan of correction.

Intermediate Care Facilities 

Writing Acceptable Plans of Correction for ICFs/IDD 

https://apps.hhs.texas.gov/PROVIDERS/Training/jointtraining.cfm to register and learn more about other joint provider training.

Scope and Severity Webinar Now Available

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

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

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

  Register at:   https://apps.hhs.texas.gov/providers/training/jointtraining.cfm

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

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

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

View the order at:  https://open.texas.gov/uploads/files/organization/opentexas/EO-GA-34-opening-Texas-response-to-COVID-disaster-IMAGE-03-02-2021.pdf

Tax Deadline Extensions for Individuals and Businesses

The IRS announced last week that because of last month’s winter storms, Texans will have until June 15, 2021, to file their individual and business tax returns and make tax payments.

This includes 2020 individual and business returns normally due on April 15, as well as various 2020 business returns due on March 15. Among other things, this also means that affected taxpayers will have until June 15 to make 2020 IRA contributions. The June 15 deadline also applies to quarterly estimated income tax payments due on April 15 and the quarterly payroll and excise tax returns normally due on April 30.

The IRS automatically provides filing and penalty relief to any taxpayer with an IRS address of record located in the disaster area, so taxpayers do not need to take any additional action to receive relief.

You can read the full announcement on the IRS website below:

https://www.irs.gov/newsroom/victims-of-texas-winter-storms-get-deadline-extensions-and-other-tax-relief

HCS/TxHmL & CLASS Programs

If you have questions about CLASS Program Policy, call 512-438-5077, 877-438-5658 or email ClassPolicy@hhsc.state.tx.us.

For questions about HCS Program Policy, call 512-438-4478 or email HCSPolicy@hhsc.state.tx.us.

For questions about TxHmL Program Policy, call 512-438-4639 or email TxHmlPolicy@hhsc.state.tx.us.

(TxHmL) billing and payment reviews, call the Billing and Payment Hotline at: 512-438-5359 or email: HCS.TxHml.BPR@hhsc.state.tx.us.

For questions about policy for HCS TxHmL, email: HCSpolicy@hhsc.state.tx.us  or
TxHmLpolicy@hhsc.state.tx.us.

For questions about HCS, TxHmL, CLASS, or DBMD Program Enrollment/Utilization Review (PE/UR): Intellectual Disability‑Related Conditions (ID/RC) Assessment Purpose Codes, Level of Need, Level of Care, and Individual Plan of Care (IPC),

call HCS or TxHmL at: 512-438‑5055 or Fax: 512-438‑4249.
Call CLASS or DBMD at: 512-438-4896 or Fax: 512-438-5135.

For questions about Vendor Holds for HCS/TxHmL, call 512-438-3234 or email: IDDWaiverContractEnrollment@hhsc.state.tx.us.

For questions about Individual Rights (individual/family complaints concerning LIDDA, HCS, and TxHmL), call IDD Ombudsman at 800-252-8154 or email: OmbudsmanIDD@hhsc.state.tx.us. Learn more about the IDD Ombudsman at https://hhs.texas.gov/idd-help.

If you have questions about Medicaid eligibility, applied income, and name changes, contact a Medicaid for the Elderly and People With Disabilities (MEPD) worker, or the Integrated Eligibility and Enrollment (IEE) Call Center at telephone number 2‑1‑1 or visit the website: https://yourtexasbenefits.hhsc.texas.gov/.

If you have questions about Days paid and services paid information for cost reports, use TexMedConnect to submit a batch of CSIs.

If you have questions about Rate Analysis contacts visit this website:
https://rad.hhs.texas.gov/long-term-services-supports/contact-list. Contact information is listed by subject.

If you have questions about how to prepare a cost report (forms and instructions) and approved rates posted, visit this website: rad.hhs.texas.gov/long-term-services-supports then select the appropriate program.

If you have questions about how to sign up for, or obtain direct deposit, or how to sign up for electronic funds transfer, call Accounting at: 512-438‑2410.

If you have questions about how to obtain IRS Form 1099‑Miscellaneous Income, call Accounting at: 512-438‑3189.

For questions about ICF/IID durable medical equipment (DME), DME authorizations, Home and Community‑Based Services (HCS), Texas Home Living Waiver (TxHmL), home modifications, adaptive aids, and dental services approvals, call Provider Claims Services at: 512-438‑2200, Option 5.

ICF/IID

If you have questions about ICF/IID and nursing facility contract enrollment, call 512-438‑2630.

If you have questions about the HHS Quality Monitoring Program, email: QMP@hhsc.state.tx.us.

For questions about Payment information for cost reports or a Quality assurance fee (QAF), call 512-424-6552.

For questions about Health and Human Services Commission Network (HHSCN) connection problems, call 512-438‑4720 or 888-952-4357.

For questions about ICF/IID durable medical equipment (DME), DME authorizations, Home and Community‑Based Services (HCS), Texas Home Living Waiver (TxHmL), home modifications, adaptive aids, and dental services approvals, call Provider Claims Services at: 512-438‑2200, Option 5.

For questions about ICF/IID/Residential Care (RC) Individual Movement Form IMT/service authorization, call Provider Claims Services at: 512-438-2200, Option 1.

For Client Assessment Registration (CARE) System Help Desk for ICF/IID, call 888-952-4357.
Request HHSC Field Support staff.

For questions about Program enrollment/Utilization Review (PE/UR), Intellectual Disability‑Related Conditions (ID/RC) Assessment Purpose Codes, Level of Need, & Level of Care call 512-438‑5055 or Fax: 512-438‑4249.

For questions about Provider contracts and vendor holds for ICF/IID or Provider access to ICF/IID CARE system, call 512-438‑2630.

For questions about MDS 3.0, MDS Purpose Code E, and Forms 3618 and 3619 missing/incorrect information, call Provider Claims Services at: 512-438‑2200, Option 1.

For questions about Rehabilitation and specialized therapy/emergency dental/Customized Power Wheelchair (CPWC) service authorizations, call Provider Claims Services at: 512-438‑2200, Option 6, or
Fax: 512-438-2302.

For questions about invalid or inappropriate recoupments for ICF/IIDs, call the HHSC Help Desk at: 512-438-4720 or 800-214-4175.

For questions about Consumer Rights and Services, call Consumer Rights and Services at: 800‑458‑9858, email: ciicomplaints@hhsc.state.tx.us, or visit the website at: https://hhs.texas.gov/about-hhs/your-rights/consumer-rights-services.

Certain Medicaid Waiver Payments May Be Excludable From Income

See the following IRS page for the full FAQ

https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income

Last Update: New Q&A’s 1-20 were added on February 23, 2015. The original text and Q&A’s follow at the end.

On January 3, 2014, the Internal Revenue Service issued Notice 2014-7, 2014-4 I.R.B. 445. Notice 2014-7 provides guidance on the federal income tax treatment of certain payments to individual care providers for the care of eligible individuals under a state Medicaid Home and Community-Based Services waiver program described in section 1915(c) of the Social Security Act (Medicaid Waiver payments).

Section 1915(c) enables individuals who otherwise would require care in a hospital, nursing facility, or intermediate care facility to receive care in the individual care provider’s home. The notice provides that the Service will treat these Medicaid waiver payments as difficulty of care payments excludable from gross income under § 131 of the Internal Revenue Code.

Individual care providers who receive Medicaid waiver payments for the care of eligible individuals in their homes and payers of Medicaid waiver payments have raised several questions not addressed in Notice 2014-7. The following questions and answers clarify the notice and provide guidance on the information reporting requirements, and the employment tax requirements for Medicaid waiver payments described in the notice.

Individual Care Provider Questions

Q1. I receive payments under a state Medicaid program other than a Medicaid Home and Community-Based Services waiver program for the personal care of my adult disabled son in our home. May I exclude these payments from gross income?

A1. Whether the Service will treat payments under a state program other than a state Medicaid Home and Community-Based Services waiver program as difficulty of care payments excludable from gross income will depend on the nature of the payments and the purpose and design of the program.

Q2.  I moved into my elderly mother’s home to care for her, and I do not have a separate home where I reside. I receive payments under a state Medicaid Home and Community-Based Services waiver program for personal care and supportive home care. Am I considered to be providing care in “the provider’s home” for purposes of Notice 2014-7?

A2. Yes. Under § 131, “the provider’s home” means the place where the provider resides and regularly performs the routines of the provider’s private life, such as shared meals and holidays with family. See Stromme v. Commissioner, 138 T.C. 213 (2012). In this situation, the mother’s home became the provider’s home because it is where the provider resides and regularly performs the routines of the provider’s private life.

Q3. I am an individual who cares for an unrelated elderly person five days a week in her home, and I have a room in the care recipient’s home where I sleep four nights a week. I receive Medicaid waiver payments for this care. On weekends and holidays, I reside with my family in our separate home. May I exclude these payments from gross income?

A3. No. In this situation, the provider works in the care recipient’s home, but the provider has a separate home where the provider resides and regularly performs the routines of the provider’s private life, such as shared meals and holidays with family. Therefore, the provider does not provide care for the care recipient in the provider’s home, and the provider may not exclude the Medicaid waiver payments from gross income.

Q4. I am an individual who cares for an unrelated elderly person seven days a week in her home where I live. I receive Medicaid waiver payments for this care. I do not have another home. May I exclude these payments from gross income?

A4. Yes. In this situation, the care recipient’s home is also the care provider’s home, and the care provider does not have a separate home. Therefore, the Medicaid waiver payments are excludable from the care provider’s gross income for the care furnished in the shared home.

Q5. I am the parent of a disabled child, and I receive state Medicaid Home and Community-Based waiver payments excludable from gross income under Notice 2014-7 for the care of my child in our home. My sister lives with me, and she also receives state Medicaid Home and Community-Based waiver payments for the care of my child. May she exclude the Medicaid waiver payments from gross income?

A5. Yes. More than one care provider living in the home with the care recipient may exclude state Medicaid Home and Community-Based waiver payments from gross income under Notice 2014-7.

Q6. I am a respite care provider, and I provide personal care and supportive services to disabled individuals in their homes, or in my home where the care recipient does not live. I receive payments for this care under a state Medicaid Home and Community-Based Services waiver program. May I exclude these payments from gross income?

A6. No. The exclusion only applies to payments for care in the individual care provider’s home where the care recipient lives under the recipient’s plan of care.

Q7. I am an individual care provider, and I receive payments under a state Medicaid Home and Community-Based Services waiver program for the care of a disabled individual who lives with me in my home under the individual’s plan of care. The program has a cost-sharing provision that may require an individual to pay the administrator of the program a portion of the total amount that the administrator pays me for the care of the disabled individual. May I exclude the entire payment that I receive from the administrator for the individual’s care?

A7. Yes. You may exclude the entire payment that you receive under the state Medicaid waiver program for the care of the disabled individual in your home even though the individual is required to pay the administrator part of the cost of the care. By contrast, an individual care provider may not exclude direct payments from a care recipient who pays part or all of the cost of the recipient’s care with the care recipient’s private funds.

Q8. I am an individual care provider, and I receive vacation pay from the state, as well as Medicaid waiver payments for the care that I provide to a disabled individual living in my home under the individual’s plan of care. May I exclude the vacation pay from gross income?

A8. No. The only amounts excludable from gross income under Notice 2014-7 are payments for the care of the disabled individual.

Q9. I received payments described in Notice 2014-7 that are treated as difficulty of care payments under § 131. May I choose to include these payments in earned income for purposes of the earned income credit (EIC) or the additional child tax credit (ACTC)? (Added May 8, 2020.

A9. Yes, for open tax years, you may choose to include all, but not part, of these payments in earned income for determining the EIC or the ACTC, if these payments are otherwise earned income (wages or income from self-employment).

Q10. If I received payments described in Notice 2014-7 in an earlier year, may I file an amended return to exclude the payments from gross income that I reported as income in the earlier year?

A10. Yes. You may file a Form 1040-X, Amended U.S. Individual Income Tax Return, if you received payments described in the notice in an earlier year and the time for claiming a credit or refund has not expired under § 6511 of the Internal Revenue Code. A taxpayer generally may file a claim for refund within three years from the date the return was filed or two years from the date the tax was paid, whichever is later. For more information, see “When To File” in the instructions to Form 1040-X or Tax Topic 308, Amended Returns, available at /taxtopics/tc308.html. In Part III of Form 1040-X, you should explain that the payments are excludable under Notice 2014-7. Excluding payments described in the notice in an earlier year may affect deductions or credits that you claimed for the earlier year, as well as other tax items for the earlier year. To help expedite the processing of your amended return, you should include the following to substantiate your claim: (1) the full name of the individual receiving care (and the care recipient’s social security number or other taxpayer identifying number, if available); (2) copies of documents from third parties to show that you and the individual receiving care resided in the same home in the year to which the claim relates (such as a driver’s license or other government-issued document, social agency document, bank statement, medical bill, or utility bill); and (3) evidence that the individual is receiving care under a state Medicaid waiver program.

To read more of this FAQ go to…. https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income

OFF-SITE CONSULTATION:  $75/hr

You can purchase 1, 3, 6, 9 or 12 hrs of off-site consultationfor assistance with HCS, TxHmL, or ICF and Additional IDD Waiver Programs.

This includes: research, phone calls, video chats, webinars, emails and texts. 

You may use this off-site consultation time as needed or all at once.  You can schedule a conference call, video chat or short training webinar with us, depending on your needs or contact us via email or text for questions you might have.  We bill a minimum of 15 mins. per contact.

After you make payment for a service, someone will contact you to schedule an appt. as soon as possible to set up initial services.  Please be sure to email us with your basic contact information and purpose for services at:

https://twogetherconsulting.com/contact-us/  

or info@twogetherconsulting.com

Check out our instant services you can purchase at our “Store” page on the website:  https://twogetherconsulting.com/store/

 OFF-SITE NURSING CONSULTATION:  $75/hr

There is a separate 1-hour payment tab for nursing consultation.  You may add on as many nursing hours as you want to the payment tab!

If you would like to schedule a teleconference or video conference with our RN Consultant and your nursing department or other members of your team, please contact us at info@twogetherconsulting.com  

This is a great way to prepare for a survey, discuss post-survey concerns, develop ideas for plans of correction, discuss nursing concerns about an individual prior to admission, or assist nurses with new admissions to the program.  

This service does not include the actual development of policy & procedure or assistance with writing plans of correction/corrective action plans..

**We also offer an initial hour of consultation to see if we can help you with applying to become an HCS/TxHML provider.   $75.00 for 1 hr max/ Initial consultation only. 

We do not provide more than 1 hr at this rate! 

12/28/20

IMPORTANT REMINDER!

HCS and TxHmL Program Providers and LIDDA Service Coordinators- IL20-45

HHSC is automatically renewing individual plans of care and Intellectual Disability/Related Condition assessments that expire on or before Dec. 30, 2020. This is due to the COVID public health emergency. The renewal is for one year from the expiration date.

HHSC is not automatically renewing IPCs and ID/RCs that expire on or after Dec. 31, 2020.  This is explained in IL 20-45 (PDF). Program providers and LIDDA service coordinators must conduct service planning team meeting on or before the effective date of the renewal IPC to develop proposed renewal IPCs and updated ID/RCs for submission to HHSC. The effective date of the renewal IPC is the day after the IPC expires.

You may conduct the SPT meeting to renew the ID/RC by telehealth. You my conduct the SPT meeting to renew the IPC by telehealth or phone. If you are not able to get the signature of the individual or legally authorized representative on the proposed renewal IPC, you must get their oral agreement to the renewal IPC and document such agreement in the individual’s record.

Program providers cannot bill for services provided when a renewal IPC is not authorized by HHSC. This means that if a SPT meeting does not occur on or before the effective date of the renewal IPC, the program provider cannot bill for services provided between the date of the meeting and the effective date of the renewal IPC.

10/29/20

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

This information letter (IL)explains:

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

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

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

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

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

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

January Webinar – Flu & COVID: What You Need to Know

HHSC is holding this webinar for all our providers to offer guidance on flu and COVID-19.

In this webinar, we will review:

• The similarities and the differences between flu and COVID-19
• The importance of getting a flu shot
• How flu vaccination along with good infection control practices protect everyone
• Centers for Disease Control and Prevention guidance on administering flu vaccines this season amid the coronavirus pandemic.

This webinar is appropriate for all provider types. No continuing education hours or units are available for this webinar. A certificate of attendance will be provided.

Jan. 5, 2021
10 – 11 a.m.
Register for the Jan. 5 COVID-19 webinar.

Jan. 21, 2021
10 – 11 a.m.
Register for the Jan. 21 COVID-19 webinar.

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

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

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

D E C // 1 8 // 2 0 2 0

AADMD Releases Statement on Covid-19 Vaccine Equity for People with IDD
Read the Official Statement – and Join the Movement

The Covid-19 vaccine is here – and AADMD joined forces with like-minded organizations to issue a Joint Position Statement on “Equity for People with Intellectual and Developmental Disabilities (IDD) Regarding COVID-19 Vaccine Allocation and Safety.”

NCD Opportunity

Through board member Rick Rader, MD — who was appointed to the National Council on Disability earlier this year — AADMD was also given the opportunity to review the NCD’s official vaccine statement as well. In response to this honor, Emily Johnson, MD VP of Policy issued the below statement:

“The AADMD was pleased to see the NCDs Statement on the allocation of COVID19 vaccines for people with intellectual disabilities was in alignment with the principles initiated, proposed and promoted by the AADMD.” If people need dentist related information, they can click for more info here!

AADMD’s Joint Position Statement

“The development of a safe, effective vaccine is a critical component of the global response to the coronavirus disease 2019 (COVID-19) pandemic. Vaccine distribution and allocation must be done in a safe and equitable manner, and individuals with intellectual and developmental disabilities (IDD) must be explicitly addressed in any framework for vaccine allocation. The aim of this joint position statement is to address the risks facing people with IDD during the pandemic and to recommend how they should be included in vaccine allocation frameworks. The final provisions for vaccine allocation will ultimately be determined on a state level, and many different allocation frameworks exist. The following recommendations are intended to be broadly adaptable to state and national allocation frameworks…”  

Read more, click on link below:

https://static1.squarespace.com/static/5cf7d27396d7760001307a44/t/5fd9690f9e3b1725e3d0d3e2/1608083731221/Covid19Vaccine-IDD-Statement.pdf

Twogether Consulting has added some new services to include:

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

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

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

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

Appendix K-Emergency Preparedness and Response-COVID-19

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

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

OFF-SITE SERVICES TIME BLOCKS:  We now offer packages of 1 hr, 3 hrs, 6 hrs, 9 hrs and 12 hrs for those of you who need quite a bit of periodic off-site assistance services including but not limited to:: Question & Answer Sessions, Resources, Individual Policies or Procedures, Creating Forms,  and Other Inquiries.  Previously we only had 3, 6, and 9 hr blocks.  12-hr blocks purchased at one time will be at $60/hr (Total= $720)  For more information go to:  https://twogetherconsulting.com/services/off-site-services/   You may request an invoice or make direct payment instead to:  https://twogetherconsulting.com/payments/

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

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

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

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

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

 [NPR §303.0015 ]

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

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

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

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

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

There are two kinds of nursing peer review:

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

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

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

 Provider Specific Training offered by Twogether Consulting

• Training (Off-site) to Providers concerning Direct Care staff’s interaction with Surveyors during interviews and how this can affect the provider, particularly the nursing department, as well as preparing for the survey in general.  (HCS, TXHmL, and ICF)
• Training (Off-site) to Providers concerning “Expectations of The Nurse Part I and II”  (HCS, TXHmL, and ICF)
• Training (Off-site) to Providers concerning Nursing Staff’s interaction with the Surveyors, particularly during the interview process with the nurse.  (HCS, TXHmL, and ICF)
• Training (Off-site) Other Direct Care staff training such as Abuse Neglect & Exploitation Reporting and Follow-Up for HCS/ICF, including PPT handouts,  Quiz and Inservice Sheet for your records or Certificates of Completion. This training does meet the new requirements listed in the current HCS TAC Code 9.175     Geared towards CM’s, QIDP’s, Nurses, Quality Assurance, Program Managers and  other Administrative Staff                                                   

• ---

• Other Direct Support Staff Training Webinars:  We continue to offer DIT’s (Directive Inservice Trainings) for ICF as well as General Direct Support Training for HCS/TxHmL/ICF providers.  Here are just some of our training webinars currently available live and/or via pre-recorded sessions:
• Abuse/Neglect/Exploitation-specific to Direct Support Staff
• Direct Support Documentation (Service Delivery Logs/Residential Notes, Incident Reports, Behavioral Support Documentation and Data Collection, and Training Data Collection),
• Elements of the Behavior Support Plan & The Importance of Your Documentation,
• Expectations From the Nurse of The DSP (Includes discussion of Medical Documentation as well-MARS, Medication Errors, Treatment Sheets, Significant Observations), 
• When and What to Report To The Nurse,
• SAM’s Training (Self-Administration of Medications Training To Staff-General Routes, Tasks, documenting), ,
• Host Home/Companion Care Service Provider Responsibilities,
• What The Nurse Expects from the HH/CC Provider and/or CRA, and many other training webinars.

Check out our page at “Gotostage” where we are providing  recordings of our free webinar sessions and other education For HCS, TxHmL, and ICF Providers

https://www.gotostage.com/channel/3b0bd3b1a47c4e80be974f4bcfa54d7b

September 15th, 2020

Abuse, Neglect, and Exploitation Competency Training and Exam

Now Available in Spanish!!   

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

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

To access the training and exam:

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

ANE Competency Training & Exam

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

Home and Community-Based Services

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

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

Texas Home Living

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

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

Reporting a Death to HHSC in the HCS/TxHmL Programs

September 3rd, 2020

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

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

 

August 10th, 2020

Administrative Penalties Update!

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

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

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

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

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

June 25, 2020

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

View the webinar recording here

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June 7th, 2019

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

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

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

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

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

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

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

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

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

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

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