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, the Texas Health and Human Services Commission (HHSC) is clarifying the actions that are required by submitters and how they align with processes in the 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 status require action from the submitter, usually the submission of supporting documentation. The IPC will not be reviewed until action is taken. This is the same process that is in place for Exceeds flags in ID-CARE.
A packet submitted to Utilization Review (UR) must include the following:
- 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 a breakdown of nursing and behavior hours if they are part of the request
A packet may include the following, depending on the services that are requested:
- Comprehensive Nursing Assessment (Form 8584 or a form with all the same elements) for nursing hours
- Occupational therapy (OT) evaluation, treatment plan, or assessment (including orders) for OT hours
- Physical therapy (PT) evaluation, treatment plan, or assessment (including orders) for PT hours
- Speech and language therapy evaluation, plan, or assessment (including orders) for speech hours
- Dietary evaluation for dietary hours (including orders)
- Dental treatment plan, if applicable
- Behavior support plan for behavioral support hours that meets HHSC criteria
- PAS/HAB Assessment (Form 8510) for personal assistance services and habilitation (PAS/HAB) hours
- Transportation Plan (Form 3598) for transportation hours
- Audiology treatment plan (including 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 they are included in the request, including:
- 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 an annual vendor is used, three bids are needed only if an item costs $500 per month or more; otherwise, an annual vendor bid can be submitted.
- Proof of Medicaid denial and professional recommendations, as required in Appendix VII of the HCS Program Billing Requirements.
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 (three bids based on specs from licensed professional recommendations) if they are part of the request (see Section 6200 of the HCS Billing Requirements)
Enrollment and Transfer IPCs
Enrollment and transfer IPCs remain in Pending DADS Review status 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 that 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 that submitted the transfer IPC.
A transfer packet submitted to PES must include the following:
- Request for Transfer of Waiver Program Services (Form 3617)
- HCS only: Individual Plan of Care – HCS/CFC (Form 3608)
- TxHmL only: Individual Plan of Care – TxHmL/CFC (Form 8582)
If an enrollment or transfer requires utilization review, UR will contact the LIDDA that submitted the enrollment or transfer packet.
Packet and Documentation Submission Details
The most efficient way to submit HCS and TxHmL documentation is through the Attachment function in the Long-term Care Online Portal (LTCOP). For more details on attachments, refer to the “LTC Online Portal to Allow Electronic Attachments on HCS and TxHmL Waiver Program Forms” notification posted on tmhp.com on June 28, 2023.
For questions about renewal, revision, or requested call back of IPC review packets, call HHSC UR at 512-438-5055, or email deskURLONIPC@hhs.texas.gov.
For questions about enrollments or transfers, call PES at 512-438-2484, or email enrollmenttransferdischargeinfo@hhs.texas.gov.