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 forms and claims to the Texas Medicaid & Healthcare Partnership (TMHP). In response to questions and concerns related to the processing of Individual Plan of Care (IPC) forms, HHSC is clarifying required actions by submitters and how they parallel to processes in Intellectual Disability (ID) Client Assignment and Registration System (CARE).
Renewal and Revision IPCs
Renewal and Revision IPCs in either “Pending DADS Review” or “Pending Coach Review” require action from the submitter. This is typically the submission of supporting documentation. The IPC will not be reviewed until action is taken. This is the same process in place for “Exceeds” flags in ID-CARE.
A packet submitted to UR must include:
- IPC Cover Sheet (form 8599, which can be found at https://www.hhs.texas.gov/regulations/forms/8000-8999/form-8599-individual-plan-care-ipc-cover-sheet)
- Copy of signed IPC, all pages
- Person-Directed Plan
- Implementation Plans for all services on the IPC, including breakdown of nursing and behavior hours, if requesting
A packet may include, depending on the services requested:
- Comprehensive Nursing Assessment (Form 8584 or a form with all of the same elements) for nursing hours
- Occupational Therapy (OT) evaluation, treatment plan or assessment (include orders) for OT hours
- Physical Therapy (PT) evaluation, treatment plan or assessment (include orders) for PT hours
- Speech/Language Therapy evaluation, plan or assessment (include orders) for Speech hours
- Dietary evaluation for Dietary hours (include orders)
- Dental treatment plan, if applicable
- Behavior Support Plan for Behavioral Support hours that meets HHSC criteria
- PAS/HAB Assessment (form 8510) for PAS/HAB hours
- Transportation Plan (form 3598) for Transportation hours
- Audiology Treatment plan (and orders), if applicable
- Cognitive Rehabilitation Therapy plan, if applicable (in HCS)
- Support Consultation plan, if applicable (in HCS)
- Social Work plan, if applicable (in HCS)
- All documentation for Adaptive Aids, if requesting, including the following:
- A list of items to be purchased, the number of each item needed, and the cost (based on the lowest bid) for each item
- Three bids for each item. Bids from online vendors are acceptable. If using an annual vendor, three bids are needed only if an item costs $500 per month or more; otherwise, annual vendor bid can be submitted.
- Proof of Medicaid denial and professional recommendations, as required in Appendix VII of the HCS Program Billing Requirements
- Please see Section 6100 of the HCS Billing Requirements at https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/long-term-care/hcs-billing-requirements.pdf for more information.
- All documentation for Minor Home Modifications (3 bids based on the specs, specs from licensed professional recommendation), if requesting (please see Section 6200 of the HCS Billing Requirements).
Enrollment and Transfer IPCs
Enrollment and transfer IPCs remain in “Pending DADS Review” while the enrollment or transfer is being processed.
Enrollment IPCs may require additional documentation to be submitted to Program Eligibility and Support (PES). If an enrollment requires additional documentation, PES will contact the LIDDA who submitted the enrollment IPC.
Transfer IPCs always require a “transfer packet” to be submitted to PES. If a transfer packet requires additional documentation, PES will contact the LIDDA who submitted the transfer IPC.
A “transfer packet” submitted to PES must include:
- Request for Transfer of Waiver Program Services (form 3617)
- HCS Only: Individual Plan of Care (IPC) – HCS/CFC (form 3608)
- TxHmL Only: Individual Plan of Care – TxHmL/CFC (form 8582)
If an enrollment or transfer requires utilization review, Utilization Review (UR) will contact the LIDDA who submitted the enrollment or transfer packet.
Packet/Documentation Submission Details
The most efficient mode of submission for HCS/TxHmL documentation is through the IDD Operations Portal. To learn how to register and use the IDD Operations Portal or for answers to any questions, please visit https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/idd-ops-portal or email IDD_Ops_Portal@hhsc.state.tx.us. Packets may also be submitted via fax at 512-438-4249.
For questions about review packets, submitters can contact HHSC UR department at 512-438-5055 or email deskURLONIPC@hhs.texas.gov.
For questions about enrollments or transfers, submitters can contact PES at 512-438-2484 or email email@example.com.
Upcoming Provider Webinar
HHSC will discuss this topic during the December 8th, 2022, TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar.
Please click on this link to register for this webinar.
If you are unable to attend the webinar, please click on this link to access the December 8th, 2022, TMHP LTC Portal for HCS/TxHmL Providers and FMSAs Webinar recording. Please note: this recording should be available by December 15th, 2022.