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HCS and TxHmL Waiver Programs: Trending Issue Support

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Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs), and financial management services agencies (FMSAs) that bill on behalf of consumer-directed services (CDS) have been submitting claims and forms to Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers indicating that additional support is required. Resolutions to the most frequently reported issues may be found in the table below.

Topic

Resolution

 

Individual Plan of Care (IPC) Form Revisions

 

To revise an IPC Form, providers need to click the Revise IPC button in the IPC form that needs revisions.

Step-by-step instructions for completing IPC Forms and revisions can be found in the following training materials in the Long-Term Care (LTC) Online Portal User Guides for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs learning path:

  • LTC HCS and TxHmL Waiver Programs Provider User Guide
  • 3608 HCS Individual Plan of Care Item-by-Item Guide
  • 8582 TxHmL Individual Plan of Care Item-by-Item Guide

Note: To access the TMHP Learning Management System (LMS), users must have an account. Users can register for an account here. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage or send an email to TMHP Training Support for help creating an LMS account or navigating the LMS.

Topic

Resolution

 

Information About Dual Entry in the Client Assignment and Registration (CARE) and TMHP Systems

 

If the following forms have an effective or revision date prior to May 1, 2022, and were not entered into the CARE system before close of business on April 6, 2022, then they will need to be submitted by the provider or LIDDA into both the CARE and TMHP systems:

  • 8578 Intellectual Disability/Related Condition Assessments
  • 8582 TxHmL Individual Plans of Care
  • 3608 HCS Individual Plans of Care

Details are available in IL 2022-18.

Topic

Resolution

 

Claims Submission Guidelines For CARE and TMHP Systems

Claims for services delivered prior to May 1, 2022, will continue to be submitted and processed in CARE. Claims for services delivered on May 1, 2022, or later will be submitted and processed using TMHP systems.

Claims submitted for dates of service prior to May 1, 2022, must have a corresponding ID/RC Assessment or IPC for those dates in the CARE system.

Claims submitted for dates of service on May 1, 2022, or later must have a corresponding ID/RC Assessment and IPC in the TMHP Long-Term Care (LTC) Online Portal. Details are available in IL 2022-18.

Topic

Resolution

 

Provider Location Update (PLU) Form Status

 

If a provider’s PLU Form moves to Provider Action Required (PAR) status, then there is an issue with the data submitted in the form.

To correct the issue, providers will need to submit a new PLU Form with the corrected data. Providers can find details about what data should be corrected in the PAR status history notes for their PLU. 

Topic

Resolution

 

TMHP Claims and Forms Submission Information Resources

Providers should use the Texas Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Bill Code Crosswalk for the Line Item Control Number (LICN) and other important information when submitting claims.

Frequently asked questions about the LICN can be found in the HCS and TxHmL Waiver Programs Frequently Asked Questions document. Providers can find detailed information about submitting claims to TMHP in the HCS and TxHmL TexMedConnect Claims Submission Webinar recording.

Detailed information about the forms submitted using the LTC Online Portal can be found in the user guides and item-by-item guides in the Long-Term Care Online Portal User Guides for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs learning path on the TMHP LMS. Each form has a corresponding item-by-item guide to help providers fill out the necessary fields.

Note: To access the LMS, users must have an account. Users can register for an account here. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage or send an email to TMHP Training Support for help creating an LMS account or navigating the LMS.

 

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For additional questions, contact the TMHP LTC Help Desk at 800-626-4117. Select option 1 and then option 7.