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Important IPC Information for CDS Claims for HCS and TxHmL Waiver Programs

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Data that providers enter into the Individual Plan of Care (IPC) for the IPC year must be correct before billing for Consumer Directed Services (CDS).

Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver program providers, as well as Local Intellectual Developmental Disability Authorities (LIDDAs), should enter the dollar amount in the following IPCs and their fields for CDS services:

For IPC 3608, the fields are:

31a, Consumer Directed Services Agency Authorized Units

LTC Online Portal Individual Plan of Care screenshot

87b, Authorized Units

LTC Online Portal Individual Plan of Care screenshot

 

For IPC 8582, the fields are:

31, Consumer Directed Services Agency Authorized Units

LTC Online Portal Individual Plan of Care screenshot

87b, Authorized Units

LTC Online Portal Individual Plan of Care screenshot

If a CDS service is billed using units instead of dollars, providers are at risk of not getting the correct dollar amount for their claim.

Note: CDS and Community First Choice (CFC) financial management services (service codes 63V and 63CFV) are not billed by dollar amounts; they are billed by units.

IPC Form Corrections

Claim submitters should check the information in the submitted IPC or Medicaid Eligibility Service Authorization Verification (MESAV) before they bill for CDS services to ensure that the information is correct and that dollar amounts have been used for the CDS service being billed.

If incorrect data is submitted, the authorized form submitter must make a correction using the Correct this form function. To make a correction, use “FSI” or “Current Activity” in the Long-Term Care (LTC) Online Portal navigation bar to locate the form that requires correction. 

The Correct this form function will be available on the individual’s most recent IPC form. The Authorized Units fields will be enabled for update after the provider clicks the Correct this form button on IPC Enrollments, IPC Renewals, and IPC Revisions. For IPC Transfers, the Correct this form function allows users to update the worksheet in the Section Transfer tab. Then the Calculate IPC button will be available.

Note: If the Correct this form button is unavailable, users should contact the LTC Help Desk at 800-626-4117.

If the IPC Type is Initial, Revision, or Renewal, corrections cannot be made if the status is one of the following:

  • Pending SAS Update
  • Invalid/Complete
  • Submit to SAS
  • Corrected
  • Inactivated

If the IPC Type is Transfer, corrections can be made if the form is in one of the following statuses:

  • Remanded to Submitter
  • Provider Action Required

Note: For IPC type Initial or Transfer, the Correct this form button will only be available for local authorities (LAs).

More Information

For more information, refer to the “Corrections” section of the Long-Term Care Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs Provider User Guide in the TMHP Learning Management System (LMS). For more information about IPC forms, providers and LIDDAs can refer to the TMHP article “Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs.”

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 on the LMS home page or send an email to TMHP Training Support to get help with creating an LMS account or navigating the LMS.

For additional questions about IPC, providers and LIDDAs can refer to HCS and TxHmL Waiver Programs Frequently Asked Questions or call the HCS/TxHmL Utilization Review (UR) Message Line at 512-438-5055.