Table of Content
Upon receipt of the written notification, the case worker must contact the individual within two business days to review the service plan and resolve the reported request for a change in tasks or hours. If the individual consents to the initial service plan developed by the case worker, the case worker sends the provider Form 2067, Case Information, advising that the individual is in agreement with the developed service plan. If the individual states that a change is needed, review and update Form 2060, Needs Assessment Questionnaire and Task/Hour Guide, and include the changes on Form 2101 to the provider. Services must be authorized within five days of receipt of the practitioner's statement. If a notification is received after services are authorized, process as an interim change.
Depending on the type of error, return the practitioner's statement to the provider for correction or get the information by phone and request faxed confirmation when necessary. The provider must send the complete practitioner's statement to HHSC within seven working days of service initiation. If the authorization Form 2101 is not received from the HHSC nurse within 30 calendar days after sending the referral Form 2101 to the provider, check with the HHSC nurse to see if the referral was received from the provider. If not, contact the provider and request Form 3052 be sent to the HHSC nurse.
Texas HCSSA Provider Directory
If the region elects to have the regional nurse notify the case worker by email, the nurse must include the individual's name, identification number, type of case action (initial, annual reauthorization, etc.) and date of authorization in the email. The unit supervisor and/or other appointed HHSC staff will also receive the notice. The case worker must go into SASO and print a copy of Form 2101 from SAS and a copy of the email for the case record. The need for Primary Home Care and Community Attendant Services must be documented by a practitioner's statement of medical need. As part of the determination of eligibility for Title XIX personal attendant services , case workers must verify that applicants have a medically related health problem that causes a functional limitation in performing personal care. PHC and CAS provide in-home personal attendant services to individuals eligible under Title XIX Medicaid or under §1929 of the Social Security Act, respectively.
If the individual begins receiving Residential Care through HHSC, the Title XIX PAS service is terminated effective no later than the date RC services begin. If three or fewer persons live in the home, the proprietor can be the PAS attendant for the individual who resides there. Evaluate the effect that going without certain critical purchased tasks would have on a recipient to determine priority status. The attendant cannot be a legal or foster parent of a minor child who receives the service, or the service recipient's spouse. Any other skilled services identified by the Texas Health and Human Services Commission nurse. Bi-weekly amounts must be multiplied by 2.17 to obtain a monthly amount, which can then be divided by 4.33 to obtain a weekly amount.
Service Interruptions
TexasLawHelp.org offers forms and educational resources to help Texas Residents assert their legal rights. The section on Medicare and Medicaid has articles on what to do if you've been denied Medicaid, how to get covered benefits and other topics related to Medicaid and public benefits in general. The STAR+PLUS waiver is available to Texas Medicaid enrollees who are at least 65 years old or have a qualifying disability. To qualify for this waiver, you must work with a service coordinator to determine which supports are a good fit for your needs. If you’re not already enrolled in Medicaid, you can apply by visiting the Your Texas Benefits website.
The change in tasks does not increase the total approved hours of service or continue for more than 60 days. When the case worker transfers an individual from Family Care to Primary Home Care or Community Attendant Services , send a referral packet to the receiving provider. The provider will begin pre-initiation activities, as well as coordinate the end date for FC and begin date for PHC/CAS, with the case worker or Texas Health and Human Services Commission nurse. The provider may contact the case worker's supervisor if the case worker has a pattern of transferring individuals to other providers even though they have indicated that it is due to reasons beyond their control. The case worker may also contact the contract manager if the provider frequently submits Form 2067, Case Information, to the case worker about a delay in initiating services. Also use this process when an individual’s time-limited benefits end after the annual certification.
In-Home Attendant Services
The authorization in SASOW is required with or without any changes in the service plan. The annual reauthorization is due by the end of the 12th month from the last annual authorization. Complete a functional assessment early enough for the reauthorization process to be completed within the 12-month time frame. If possible, complete the annual functional reassessment during the fourth 90-day monitoring visit for the year. If the annual reassessment is not completed during the fourth 90-day monitoring visit, then another home visit is required to complete the reassessment.
The increase should not be delayed solely because the delay is more convenient for the provider. Depending on the individual's new condition or situation, a new assessment or revision of the service plan may be necessary. If appropriate, make changes to the service plan on Form 2101, Authorization for Community Care Services, according to Section 2720, Interim Changes. If the change in circumstances meets the criteria for Adult Protective Services, refer the individual to that service.
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State law requires that home and community support services agencies that provide personal attendant services be licensed by the Texas Health and Human Services Commission . It is possible for a Medicaid-eligible person to begin receiving services before HHSC receives a referral for Primary Home Care . The information below states the procedures case workers, HHSC nurses and providers must use when processing an application for retroactive payment. For Primary Home Care cases at reassessment with no changes, the service authorization is open ended and nothing is sent to the provider.
Louisiana and Arkansas both have lower monthly costs, averaging $3,623 per month and $4,185 per month, respectively. In-home care in Texas is also $381 per month lower than the national average of $4,957. Someone in the individual's home exhibits reckless behavior that may result in imminent danger to the health and safety of the individual, the attendant or another person.
If eligibility is reinstated without a gap in eligibility dates, no further action is needed. See Section 3441, Loss of Categorical Status or Financial Eligibility, Section 3441.1, Procedures Pending Reinstatement, and Section 3441.2, Reinstatement Procedures After Denial, for case worker procedures. For changes made in conjunction with an annual reassessment of Community Attendant Services cases, the Texas Health and Human Services Commission nurse must authorize the change.
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