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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 11

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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) billing on behalf of consumer-directed services (CDS) have been submitting claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers and LIDDAs indicating that additional support is required. Resolutions regarding the most frequently reported issues may be found in the tables below.

Topic

Resolution

Form statuses

The following is a list of common form submission statuses with descriptions and actions needed:

  • Pending DADS Review
    • Description: The form is pending Texas Health and Human Services Commission (HHSC) long-term care (LTC) staff review.
    • Action: 
      • Forms 8578, 3608, and 8582: For Change LON on Existing Assessment, renewals and revisions, the submitter may need to submit a review packet to the HHSC Utilization Review (UR) department. For questions and to provide supplemental documentation, submitters can contact the HHSC UR department at 512-438-5055 or email deskURLONIPC@hhs.texas.gov
      • 8578, 3608, 8582, and 3615 Forms: For questions and to provide supplemental documentation about enrollments, transfers, or continuation of suspensions, LIDDAs can contact HHSC Program Eligibility and Support (PES) at 512-438-2484.
      • 3616 Termination Forms: For questions and to provide supplemental documentation, providers and LIDDAs can contact HHSC Program Eligibility and Support (PES) at 512-438-2484.
  • Suspension Review Overdue
    • Description: Suspension forms are due for review every 30 calendar days. If 30 calendar days have expired, and the submitter has not documented the suspension review, the Individual Movement Form (IMT) is set to status Suspension Review Overdue, and a note reading, “Suspension review is overdue. Please document the suspension review” is added to the History trail.
    • Action: The submitter needs to enter their review comments. For more information, including instructions and screenshots, users can refer to the “Suspension Review Process” section of the LTC HCS and TxHmL Waiver Programs Provider User Guide.
      Note: To access the TMHP Learning Management System (LMS), users must have an account. Users can register for an account on this LMS web page. New TMHP LMS users can access the LMS Registration and Navigation Job Aid for Providers located on the LMS home page or send an email to TMHP Training Support for support on creating an LMS account or navigating the LMS.
  • Submitted to PCS
    • Description: The HHSC Provider Claims Services (PCS) staff assists the submitter with form processing and service authorization creation.
    • Action: The HHSC PCS staff is responsible for assisting the submitter with obtaining Complete status for their form. In this status, the form can be resubmitted to the Service Authorization System (SAS) and set to status Submit to SAS. It can be marked invalid if HHSC PCS staff has determined that the transaction is invalid and the form status is set to Invalid/Complete. The form can also be marked complete if HHSC PCS has taken action to resolve the issue within SAS and is set to status PCS Processed/Complete. The form can be sent to an HHSC PCS Coach for review and set to status Coach Review. If HHSC PCS requests more information from the provider or LIDDA, the form is set to status Pending More Info.
      The submitter can call PCS at 512-438-2200, option 5, for further assistance.
  • Pending LA Review or Pending New LA Review
    • Description: The form has been routed to the LIDDA for review or acknowledgment.
    • Action: The LIDDA can review the forms by utilizing the Forms Status Inquiry (FSI) function to search for forms in Pending LA Review status. For LA Reassignment forms, the new LIDDA can utilize the FSI function to search for forms in Pending New LA Review status and then indicate the new service coordinator for the individual on the form.Users can refer to the “LIDDA Review Process” sections of the LTC HCS and TxHmL Waiver Programs Provider User Guide for instructions on completing the review process.
  • Remanded to Submitter
    • Description: The form has been returned to the original submitter for corrections.
    • Action: The submitter will need to review the history notes in the form and follow the instructions to address the remand reason. Be sure to click the Add Note button on the yellow Form Actions bar to explain how the remand reason was addressed. With the addition of a note, the form reverts to the status it was in before it was remanded. When the Correct this Form button is available, submitters can correct the required information.
      For more information, users can refer to the “Add Note” and “Corrections” sections of the LTC HCS and TxHmL Waiver Programs Provider User Guide.

Out of Order form submission requests

HHSC recommends that providers and LIDDAs email HHSC PES or UR for requests regarding submissions of Out of Order forms.

For individual plan of care (IPC) transfers, email HHSC PES at enrollmenttransferdischargeinfo@hhs.texas.gov.

For IPC revisions, email HHSC UR at deskURLONIPC@hhs.texas.gov.

Note: Always include a copy of the signed IPC.

When to inactivate a form

HHSC recommends that providers and LIDDAs contact HHSC PES or UR prior to using the Inactivate button on a form.

Contact the HHSC PES team for:

  • 8578 ID/RC forms with purpose code 2.
  • Initial or transfer IPC forms.
  • Suspensions.
  • Terminations.

HHSC PES team contact information:

Contact HHSC UR for:

  • 8578 ID/RC forms with purpose code 3 or 4.
  • Renewal or revision IPCs.

HHSC UR team contact information:

LIDDAs are not permitted to use the Inactivate button on an HCS or TxHmL Pre-enrollment form. The LIDDA is required to contact the assigned Intellectual or Developmental Disability (IDD) Services slot monitor to request inactivation of a pre-enrollment form. Only the slot monitor is allowed to inactivate this form.

 

View previous postings below:

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 10

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 9

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 8

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 7

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 6

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 5

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 4

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 3

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 2

HCS and TxHmL Waiver Programs: Trending Issue Support

HCS and TxHmL Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission

Common Form Status and Workflow Resolutions for HCS and TxHmL Waiver Programs Forms

Important Claims Submission Information for HCS and TxHmL Programs

LTC Online Portal Dashboard Accessibility Issue Resolved

IPC Forms 3608 and 8582 Issue Resolved

HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022

Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs

Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP

EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission

For help with any additional questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1, then option 7).