Case Manager Community Care for Aged and Disabled Handbook
- 1000
- Program Description
- 1100
- Program Introduction
- 1110
- Legal Base
- 1120
- Program Goals
- 1130
- Definitions
- 1140
- Disclosure of Information
- 1141
- Confidential Nature of the Case Record
- 1141.1
- Confidential Information on Notifications
- 1142
- Establishing Identity for Contact Outside the Interview Process
- 1142.1
- Telephone Contact
- 1142.2
- In-Person Contact
- 1142.3
- Verification and Documentation
- 1143
- Custody of Records
- 1144
- Disposal of Records
- 1145
- When and What Information May Be Disclosed
- 1145.1
- Request for Release of Information Related to a Deceased Individual
- 1146
- Confidential Nature of Medical Information – HIPAA
- 1147
- Privacy Notice
- 1148
- Individual Authorization
- 1149
- Minimum Necessary
- 1150
- Personal Representatives
- 1151
- Adults and Emancipated Minors
- 1152
- Unemancipated Minors
- 1153
- Deceased Individuals
- 1160
- Correcting Information
- 1170
- Alternate Means of Communication
- 2000
- Case Management
- 2100
- Case Management
- 2110
- Description of Case Management
- 2120
- Case Management Process
- 2130
- Your Texas Benefits Medicaid Card and Replacement
- 2200
- Intake Procedures
- 2210
- Requests for Services
- 2211
- Applications and Referrals Routed from the Midland Document Processing Center
- 2220
- Response to Requests for Service
- 2221
- Requests for Services in STAR+PLUS Areas
- 2222
- Reinstatement Procedures for Individuals Reapplying for Services After Loss of Financial Eligibility
- 2223
- Caregiver Support Assessment Initiative
- 2230
- Interest List Procedures
- 2230.1
- Adding Individual's Name Back to CSIL
- 2231
- Community Services Interest List Bypass Criteria
- 2231.1
- Individuals Who May Receive Services with Regional Director Approval
- 2231.2
- Individuals Who May Be Placed at the Top of the Interest List
- 2231.3
- Individuals Who May Not Bypass the Interest List
- 2231.4
- Bypass Approval
- 2232
- The Community Services Interest List System
- 2240
- Regional Procedures
- 2241
- Supervisor Responsibilities
- 2242
- Case Manager Responsibilities
- 2243
- Conflicts of Interest
- 2300
- Responding to Requests for Service
- 2310
- Criteria for Immediate or Expedited Responses to Service Requests
- 2320
- Case Manager Response
- 2330
- Scheduling the Initial Interview
- 2331
- Information and Referral (I&R)
- 2332
- Requests for Services from Individuals Under Age 21
- 2333
- Applications
- 2333.1
- Required SAS Entries for Applications Withdrawn Early in the Process
- 2340
- The Initial Interview and Application Process
- 2341
- Financial Application Process
- 2341.1
- Application
for Assistance Form
- 2341.2
- Application for Assistance Form Completion and Receipt Date
- 2341.3
- Categorical Eligibility
- 2341.3.1
- Effect of QI Benefits on Eligibility for Community Care Services
- 2341.4
- Refusal to Cooperate with the Application Process
- 2341.5
- Retroactive Payment Process
- 2342
- Screening for Primary Home Care and Community Attendant Services
- 2342.1
- Receipt Date of the Application Form
- 2342.2
- Timely Referral to MEPD
- 2342.3
- Additional Screening Criteria for PHC or CAS
- 2342.4
- Applicants Not Referred for PHC or CAS
- 2342.5
- Eligibility Determination Requirements for CAS Applications
- 2342.6
- Disability Determination for Individuals Under Age 65 Applying for CAS
- 2343
- Confidentiality
- 2344
- Individual Rights and Responsibilities
- 2345
- Registering to Vote
- 2346
- Service Delivery Options
- 2347
- Texas Medicaid Estate Recovery Program (MERP)
- 2347.1
- Introduction
- 2347.2
- Presentation of Information to Community Attendant Services Applicants
- 2347.3
- Determining Grandfathered Status
- 2347.3.1
- Determining the Application Date for MERP Grandfathered Status
- 2347.4
- Medicaid Estate Recovery Program Exemptions
- 2347.5
- MERP Claims and the Filing Process
- 2347.6
- Allowable Claim Deductions
- 2347.7
- Transfer of Assets
- 2347.8
- Documenting Executor Information in SAS for CAS Individuals
- 2347.9
- Additional MERP Information
- 2348
- Retroactive Payments
- 2349
- Procedures for Applicants Aging Out of PCS to PHC
- 2400
- Assessment Process
- 2410
- Overview of the Assessment Process
- 2411
- Required Documentation
- 2420
- Assessing the Applicant’s Needs
- 2421
- Review of the Community Care Intake Form
- 2422
- Form 2059, Summary of Client’s Need for Service
- 2422.1
- Medical Diagnosis and Functional Limitations
- 2422.2
- Home Environment
- 2422.3
- Living Arrangement
- 2422.4
- Documentation of Caregivers
- 2422.5
- Attendant Policy for Individuals Transferring from Another Personal Attendant Services (PAS) Program
- 2422.6
- Common Household Tasks, Duplicate Services and Services Provided to Other Family Members
- 2422.7
- Assessment of Social and Community Resources
- 2423
- Guardianship
- 2430
- Functional Assessment
- 2431
- Form 2060, Part A, Functional Assessment
- 2432
- Scoring Persons Who Cannot Respond
- 2433
- Determining Unmet Need in the Service Arrangement Column
- 2433.1
- Assessment of the Caregiver
- 2433.2
- Exploring Other Resources for Meeting the Applicant’s Needs
- 2434
- Support Score and Establishing Priority
- 2440
- Use of Form 2060, Part B, Task/Hour Guide, and Part C, Task/Minute and Subtask Guide
- 2440.1
- Requesting Supervisory Approval for Time Outside the Minute Range
- 2441
- Circumstances When Supervisory Approval is Not Required
- 2441.1
- Exception for a Compelling Reason
- 2441.2
- Exception for Assistance from a Caregiver or other Agency
- 2441.3
- Time Allocation for Companion Cases
- 2442
- Calculation of Time to be Authorized
- 2500
- Service Planning
- 2510
- Service Plan Development
- 2511
- Caregiver Arrangements
- 2512
- Caregiver Support
- 2513
- Caregiver as the Paid Attendant
- 2514
- Who Cannot Be Hired as the Paid Attendant
- 2520
- Freedom of Choice
- 2521
- Freedom of Choice in Living Arrangements
- 2522
- Service Delivery in Alternate Locations
- 2523
- Freedom of Choice in Agency Selection
- 2530
- Other Resource Services
- 2531
- Veterans Affairs Aid and Attendance and Housebound Benefits
- 2532
- Skilled Home Health Services
- 2533
- Hospice Services
- 2534
- Mutually Exclusive Services
- 2534.1
- Services Through the Texas Home Living Waiver
- 2534.2
- Targeted Case Management and Other DADS Services or the STAR+PLUS Program
- 2535
- Involvement of Volunteer Resources
- 2540
- Priority Status Individuals
- 2550
- Identifying Individuals at Risk
- 2551
- Case Manager Actions for Individuals at Risk
- 2600
- Authorizing and Reassessing Services
- 2610
- Application Processing and Notification
- 2611
- Processing Time Frames
- 2612
- Notification of Eligibility Decision
- 2613
- Case Record Documentation
- 2620
- Service Authorizations
- 2630
- Referrals to the Provider
- 2631
- Negotiated Referrals
- 2632
- Routine Referrals
- 2640
- Provider Requirements for Hiring a Paid Attendant
- 2650
- Changes in Service Plans
- 2651
- Disagreements about Service Plans
- 2652
- Changing the Service Schedule Between Reassessments
- 2653
- Provider Flexibility
- 2660
- Reassessments and Recertification Procedures
- 2661
- Individual Unavailable for Reassessment
- 2661.1
- Delay in Home Visits Due to Individual Illness
- 2662
- Redetermination of Financial Eligibility
- 2663
- Reassessment of Functional Need
- 2663.1
- Annual Home Visit Required for Individuals Receiving PAS
- 2663.2
- Determining When a Home Visit is Necessary for Other Services
- 2664
- Redetermination of Unmet Need
- 2670
- Notifications at Reassessment
- 2680
- Recertification
- 2700
- Service Monitoring, Changes and Transfers
- 2710
- Monitoring Visits and Contacts
- 2710.1
- Monitoring Initiation of Services
- 2710.2
- Monitoring Ongoing Services
- 2710.3
- Service Plan Changes at the Monitoring Contact
- 2710.4
- Monitoring Documentation Requirements
- 2710.5
- Actions Required After Monitoring
- 2711
- Monitoring Community Attendant Services Individuals
- 2712
- Six-Month Monitoring Contacts
- 2720
- Interim Changes
- 2721
- Service Plan Changes
- 2721.1
- Individual Responsibility to Report Changes
- 2721.2
- Provider Responsibility to Report Changes
- 2721.3
- Determining if a Home Visit is Necessary
- 2721.4
- Revising the Service Plan
- 2721.5
- Long-term Versus Short-term Changes in the Individual’s Condition
- 2721.6
- Authorizing and Documenting Changes
- 2722
- Individual Moves and Case Transfers
- 2722.1
- Procedures If the Losing Case Manager Initiates Action
- 2722.2
- Procedures If the Gaining Case Manager Initiates Action
- 2722.3
- Additional Procedures
- 2722.4
- PHC and Title XIX DAHS Individuals Transferring into a STAR+PLUS Service Area
- 2722.5
- Adult Day Care and Personal Attendant Services Individuals Transferring Out of a STAR+PLUS Service Area
- 2722.6
- Shared Case Manager Responsibilities Related to Managed Care Individuals
- 2723
- Freedom of Choice
- 2724
- Medicaid Coverage for Individuals Denied SSI
- 2725
- Certificates of Insurance Coverage
- 2730
- Active Tuberculosis (TB) Diagnosis
- 2740
- Special Procedures for Helping Individuals Enter or Leave a Nursing Facility, Institution or Hospice
- 2741
- Individuals Entering a Nursing Facility
- 2742
- Closing Service Authorizations for Individuals Entering or Leaving a Nursing Facility
- 2742.1
- Individuals Entering a Nursing Facility
- 2742.2
- Individuals Leaving a Nursing Facility
- 2742.3
- Individuals Denied a Determination of Medical Necessity
- 2742.4
- Promoting Independence Initiative
- 2743
- Individuals Receiving Services through Local Authorities
- 2744
- TDC Individuals Leaving TDC
- 2745
- Individuals Who Need Hospice Services
- 2746
- Complaints, Grievances or Suggestions
- 2746.1
- Reporting Service Delivery Issues to the Consumer Rights and Services Hotline
- 2750
- Fraud Detection and Documentation
- 2751
- Provider Fraud
- 2752
- Responding to Allegations of Provider Fraud
- 2753
- Individual Fraud
- 2754
- Responding to Allegations of Individual Fraud
- 2760
- Fraud Referral
- 2761
- Development of the Fraud Referral Packet
- 2762
- Expedited Referrals
- 2763
- Referral of Potential Fraud
- 2800
- Notifications, Suspensions, Denials and Terminations
- 2810
- Individual Notification Procedures
- 2811
- Effective Dates
- 2812
- Changes in the Individual's Need for Services
- 2813
- Situations in Which the 12-Day Adverse Action Period May Be Reduced
- 2814
- Transfers Between Primary Home Care, Community Attendant Services and Family Care
- 2815
- CCAD Individuals Receiving IHFSP
- 2820
- Service Suspensions
- 2821
- Service Suspension by Providers
- 2822
- Service Suspension by Case Managers
- 2822.1
- Hospital and Nursing Facility Stays
- 2830
- Refusal to Comply with Service Delivery Provisions
- 2830.1
- Individuals Who Refuse to Comply with Electronic Visit Verification Requirements
- 2831
- Suspensions Due to Refusal to Comply with Service Delivery Provisions
- 2832
- Documentation of Compliance Issues
- 2833
- Reauthorization of Services After Termination for Refusal to Comply
- 2840
- Threats to Health or Safety
- 2840.1
- Sharing Information with New Providers Regarding Health and Safety Issues
- 2841
- Reinstatement of Services Terminated for Threats to Health or Safety
- 2841.1
- Sharing Information on Previous Actions for Reinstatement
- 2900
- Appeals and Fair Hearings
- 2910
- Individual’s Right to Appeal and Request a Fair Hearing
- 2911
- Notice to the Provider for Continuing Services
- 2912
- Special Procedures for Denials of Community Attendant Services (CAS) Individuals
- 2913
- Coordinating with Utilization Review for Fair Hearing Requests as a Result of Utilization Review Findings
- 2914
- Withdrawal of an Appeal
- 2920
- Request for Increase in Services During an Appeal
- 2930
- Fair Hearing Procedures
- 2931
- Processing Fair Hearing Requests Using TIERS
- 2932
- Coordination of Fair Hearings with MEPD Utilizing OES CRU
- 2933
- Submitting the Appeals Evidence Packet
- 2934
- Presentation of Evidence at the Fair Hearing
- 2935
- Action Taken on the Hearing Decision
- 2935.1
- Action Taken after the Hearing Decision for Reductions
- 2935.2
- Action Taken after the Hearing Decion on Terminations
- 2935.3
- Fair Hearings Officer Orders a New Assessment
- 2935.4
- Reporting the Action Through TIERS
- 2936
- Fair Hearing Exception Process
- 3000
- Eligibility for Services
- 3100
- Eligibility Determination Procedures
- 3110
- Eligibility for CCAD Services
- 3111
- Age Limits
- 3120
- Loss of Eligibility
- 3200
- Resource Eligibility Criteria
- 3210
- Resource Limits
- 3220
- Types of Resources
- 3230
- Resource Exclusions
- 3231
- Rate of Return on Income-Producing Property
- 3300
- Income Eligibility
- 3310
- Income and Income Eligibles
- 3320
- Determination of Countable Income
- 3330
- Budgeting Countable Income
- 3330.1
- Excludable Income
- 3330.2
- Exempt Income
- 3340
- Computation of Gross Income
- 3341
- Income Averaging
- 3400
- Verification Procedures
- 3410
- Verification of Public Assistance Status
- 3420
- Verification of Income and Resources
- 3421
- Financial Documentation Requirements
- 3422
- Exceptions to Verification Requirements
- 3430
- Eligibility Before Verification
- 3440
- Changes in Financial Circumstances
- 3441
- Loss of Categorical Status or Financial Eligibility
- 3441.1
- Procedures Pending Reinstatement
- 3441.2
- Reinstatement Procedures After Denial
- 4000
- Specific CCAD Services
- 4100
- Adult Foster Care
- 4110
- Description
- 4111
- Four Bed Adult Foster Care Homes
- 4112
- Small Group Homes
- 4113
- Contract Manager and Case Manager Responsibilities
- 4113.1
- Contract Manager Responsibilities
- 4113.2
- Case Manager Responsibilities
- 4120
- Eligibility
- 4121
- Basic Eligibility
- 4122
- Appropriate Characteristics for Adult Foster Care
- 4123
- Supervisory Approval
- 4130
- Adult Foster Care Intake and Assessment
- 4131
- Response to Request for Services
- 4132
- Individual Rights and Responsibilities
- 4133
- Assessing Potential Adult Foster Care Homes
- 4134
- Placement on the Interest List
- 4135
- Adult Protective Services Individuals in Adult Foster Care
- 4135.1
- Placement of Adult Protective Services Individuals in Adult Foster Care
- 4135.2
- Adult Protective Services Investigations of Adult Foster Care Providers
- 4136
- Private Pay Individuals and Retroactive Payment Procedures
- 4136.1
- Private Pay Individuals in Adult Foster Care
- 4136.2
- Retroactive Payment Procedures
- 4140
- Adult Foster Care Case Manager Procedures
- 4141
- Eligibility Determination
- 4142
- Supervisory Approval
- 4143
- Service Planning
- 4150
- Finalizing the Care Plan – Required Initial Home Visit
- 4151
- Individual and Provider Agreement
- 4152
- Personal Needs and Medical Expenses Allowance
- 4153
- Room and Board Agreement
- 4153.1
- Changes in the Room and Board Agreement
- 4154
- Leave Away from the Foster Home and Bedhold Charges
- 4155
- Authorization of Adult Foster Care
- 4156
- Adult Foster Care and Day Activity and Health Services
- 4160
- Monitoring
- 4161
- 60-Day and 90-Day Monitoring Contacts
- 4162
- Six-Month Monitoring Contact
- 4170
- Significant Changes
- 4171
- Changes in the Service Plan
- 4172
- Adult Foster Care No Longer Appropriate
- 4173
- Termination of Adult Foster Care Services
- 4180
- Annual Reassessment
- 4200
- Day Activity and Health Services
- 4210
- Description
- 4211
- Nursing and Personal Care
- 4212
- Physical Rehabilitation
- 4213
- Nutrition
- 4214
- Transportation
- 4215
- Other Supportive Services
- 4220
- Eligibility
- 4221
- Financial
Eligibility Criteria
- 4222
- Medical Eligibility Criteria
- 4223
- Unmet Need Criteria
- 4223.1
- DAHS in Conjunction with Other Services
- 4224
- DAHS Licensure Age Requirements
- 4230
- DAHS Approval
- 4231
- Intake
- 4231.1
- Facility-Initiated Referrals
- 4231.2
- Intake Response
- 4231.3
- Initial Interview
- 4231.4
- Response to Individuals No Longer Attending DAHS
- 4232
- Facility Choice
- 4233
- Initial Eligibility Determination and Referral
- 4234
- Facility Response for Facility-Initiated Referrals
- 4234.1
- Regional Nurse Responsibilities for Facility-Initiated Referrals
- 4234.2
- Case Manager Responsibilities for Facility-Initiated Referrals
- 4235
- Facility Response to Case Manager Referrals
- 4235.1
- Regional Nurse Responsibilities for Case Manager Referrals
- 4235.2
- Effective Dates for Initial Cases
- 4235.3
- Case Manager Responsibilities for Case Manager Referrals
- 4236
- Critical Omissions
- 4240
- Facility Initiation of Services
- 4250
- Monitoring
- 4260
- Changes
- 4261
- Service Plan Changes Reported by the Facility
- 4261.1
- Individual Absences
- 4262
- DAHS Transfers
- 4263
- Suspensions
- 4264
- Ensuring Health and Safety at DAHS Facilities
- 4270
- Reassessment
- 4271
- Renewal of Prior Approval
- 4300
- Emergency Response Services
- 4310
- Introduction
- 4311
- Program Definitions
- 4312
- Eligibility and Referral Procedures
- 4312.1
- Eligibility
- 4312.2
- Referral Process
- 4313
- Case Management Duties Related to Emergency Response Services (ERS)
- 4320
- Service Delivery Requirements
- 4321
- Service Initiation
- 4322
- Securing Responders
- 4323
- Equipment Installation
- 4324
- Provider Follow-Up Procedures
- 4325
- Selection of Providers and Provider Changes
- 4330
- Service Delivery
- 4331
- Alarm Calls
- 4332
- Systems Checks
- 4333
- Equipment Malfunction
- 4340
- Suspension and Termination of Services
- 4341
- Interdisciplinary Team (IDT) Meeting
- 4350
- Rates and Contracts
- 4351
- Advertising and Solicitation
- 4352
- Disclosure of Previous Employment and Certification
- 4353
- Participant Records
- 4360
- Reassessment
- 4400
- Family Care Services
- 4410
- Primary Home Care Program
- 4411
- Family Care Services Description
- 4412
- Allowable Tasks
- 4413
- Excluded Services
- 4420
- Eligibility
- 4421
- Residence
- 4430
- Case Manager Procedures for Determining Eligibility
- 4431
- Family Care Financial Eligibility
- 4432
- Family Care Functional Eligibility
- 4433
- Time Frames
- 4440
- Referral Process
- 4440.1
- Types of Referrals
- 4441
- Provider Responsibilities after Receipt of Referral
- 4441.1
- Delay of Service Initiation
- 4441.2
- Initial Service Delivery Plan Variances
- 4442
- Resolution of Service Plan Disagreement
- 4443
- Change of Providers
- 4443.1
- Service Interruptions
- 4444
- Reporting Significant Changes
- 4445
- Service Plan Changes
- 4446
- Suspension of Services and Interdisciplinary Team (IDT) Procedures
- 4447
- Reassessment
- 4448
- Complaints
- 4500
- Meals Services
- 4510
- Description
- 4520
- Eligibility
- 4521
- Home-Delivered Meals Interest List Procedures
- 4530
- Casework Procedures
- 4531
- Service Initiation
- 4532
- Individual Health and Safety
- 4532.1
- Waivers for Alternate Meal Delivery Methods
- 4533
- Suspension of Services
- 4534
- Termination of Services
- 4600
- Primary Home Care and Community Attendant Services
- 4610
- Primary Home Care Program
- 4620
- Personal Attendant Services Description
- 4621
- Allowable Tasks
- 4622
- Excluded Tasks
- 4623
- Personal Attendants
- 4624
- Priority Status Determination
- 4630
- Eligibility
- 4631
- Residence
- 4632
- Financial Eligibility
- 4633
- Functional Eligibility
- 4634
- Practitioner's Statement of Medical Need
- 4640
- Retroactive Payments
- 4641
- Provider's Role
- 4642
- Case Manager's Role
- 4643
- Applicant Approved for Retroactive Payment and Continued Services
- 4644
- Applicant Approved for Retroactive Payment and Denied Continued Services by the Case Manager
- 4645
- Special Procedures for Community Attendant Services (CAS)
- 4646
- CAS Applicant Determined Ineligible by MEPD Staff
- 4647
- Notifications
- 4647.1
- Notifications to Providers
- 4647.2
- Notifications to Applicants
- 4648
- Reimbursement
- 4650
- Service Planning
- 4651
- Assessing the Individual's Needs
- 4651.1
- Service Delivery Outside the Home
- 4652
- Types of Referrals
- 4652.1
- Routine
Referrals for Primary Home Care
- 4652.2
- Expedited Referrals for Primary Home Care
- 4652.3
- Initial Referrals for Community Attendant Services
- 4652.4
- CAS Applicants Requiring Immediate Service Delivery
- 4653
- Referral to the Provider
- 4654
- Pre-Initiation Activities
- 4654.1
- Delays in Pre-Initiation Activities
- 4655
- Initial Service Delivery Plan Changes
- 4660
- Service Authorization
- 4661
- Receipt of the Practitioner's Statement of Medical Need
- 4661.1
- Review of the Practitioner's Statement
- 4661.2
- Required Corrections
- 4662
- Authorization of Services
- 4662.1
- Authorization for Routine Referrals
- 4662.2
- Authorization for Expedited Referrals
- 4663
- Effective Dates
- 4664
- Time-Limited Services
- 4665
- Service Initiation and Delivery
- 4665.1
- Delays in Service Initiation
- 4665.2
- Service Delivery Requirements
- 4670
- Ongoing Case Management
- 4671
- Ongoing Case Manager Responsibilities
- 4672
- Transferring Individuals from Family Care to Title XIX Personal Attendant Services
- 4673
- Interim Service Plan Changes
- 4673.1
- Temporary Service Plan Variances
- 4673.2
- Ongoing Service Plan Changes
- 4673.3
- Increase in Hours
- 4673.4
- Immediate Increase in Hours
- 4673.5
- Termination or Reduction of Hours
- 4673.6
- Temporary Loss of Eligibility and Reinstatement Procedures
- 4673.7
- Implementation of Service Delivery Plan Changes
- 4674
- Service Interruptions
- 4675
- Interdisciplinary Team
- 4675.1
- Individual Reports of Service Delivery Issues
- 4676
- Change of Providers
- 4677
- Suspension of Services and Interdisciplinary Team Procedures
- 4678
- Annual Reassessments
- 4678.1
- Primary Home Care Annual Reassessments
- 4678.2
- Community Attendant Services Annual Reassessments
- 4700
- Residential Care Services
- 4710
- Description
- 4711
- Required Services
- 4720
- Eligibility for Service
- 4721
- Residential Care Eligibility
- 4722
- Emergency Care Eligibility
- 4730
- Special Casework Procedures for Residential Care
- 4731
- Assessment
- 4732
- Freedom of Choice
- 4733
- Referral
- 4733.1
- Delay of Entry into the Facility
- 4733.2
- Termination
- 4734
- Inappropriate for Residential Care
- 4735
- Duplication of Services
- 4736
- Transfers
- 4740
- Individual Contribution to the Cost of Care
- 4740.1
- Room and Board Payments
- 4740.2
- Copayments
- 4741
- Individuals on Services Before September 1, 2003
- 4742
- Case Manager Calculation Procedures
- 4743
- Waiver of Copayment
- 4744
- Adjusting Payments
- 4745
- Collection of the Individual's Contribution to the Cost of Care
- 4750
- Personal Leave
- 4760
- Hospital, Nursing Home or Institutional Facility Stays
- 4770
- Ongoing Casework Procedures
- 4771
- Facility Reporting and Notification Requirements
- 4772
- Monitoring
- 4773
- Annual Reassessment
- 4774
- Termination of Services
- 4774.1
- Termination Due to Failure to Pay the Required Contribution to the Cost of Care
- 4774.2
- Services During the Appeal
- 4774.3
- Requests to Transfer to Another Residential Care Facility
- 4780
- Special Casework Procedures for Emergency Care
- 4781
- Case Manager Assessment
- 4782
- Immediate Placement
- 4783
- Length of Stay
- 4800
- Reserved
- 4900
- Special Services to Persons with Disabilities (SSPD)
- 4910
- SSPD Program Description
- 4920
- SSPD Eligibility
- 4930
- Service Referral, Initiation and Delivery
- 5000
- Utilization Review in Community Care for Aged and Disabled Services
- 5100
- Overview of Utilization Review
- 5110
- Concurrent Reviews of Randomly Selected Active Cases
- 5200
- Utilization Review Report to the Regions
- 5210
- Other Utilization Review Reporting Processes
- 5300
- Concurrent Review Process
- 5310
- Implementation of Utilization Review Findings
- 5320
- Individual Agreement or Disagreement with the Change
- 5330
- Provider Implementation of the Change
- 5400
- Reporting Implementation of the Utilization Review Findings
- 5500
- Utilization Review Exception Process
- 6000
- Service Delivery Options
- 6100
- Agency Option (AO)
- 6110
- Description
- 6120
- Selection of a Service Delivery Option
- 6121
- Individual Decision
- 6130
- Casework Procedures
- 6200
- Service Responsibility Option (SRO)
- 6210
- SRO Description
- 6220
- SRO Roles and Responsibilities
- 6221
- Case Manager Responsibilities
- 6222
- Provider Responsibilities
- 6223
- Individual Responsibilities
- 6230
- Casework Procedures
- 6231
- Initial Authorization of Services
- 6232
- Monitoring
- 6233
- Procedures for Ongoing Cases
- 6300
- Consumer Directed Services (CDS)
- 6310
- Description
- 6311
- Risks and Advantages of the CDS Option
- 6311.1
- Risks Associated with CDS
- 6311.2
- Advantages of CDS Service Delivery
- 6320
- Roles and Responsibilities
- 6321
- Individual Responsibilities
- 6322
- Case Manager Responsibilities
- 6323
- Agency Responsibilities
- 6330
- Casework Procedures
- 6331
- Presentation of the CDS Option
- 6331.1
- Individual Decision
- 6331.2
- Selection of the Consumer Directed Services Agency
- 6332
- Initial Authorization of Services
- 6332.1
- Pre-Enrollment Requirements
- 6332.2
- Calculation of the Annual Service Plan
- 6332.3
- Monitoring CDS Service Initiation
- 6332.4
- Responsibility for Responding to Questions
- 6333
- Service Initiation Directly into CDS for PHC or CAS
- 6333.1
- Authorizing CDS for Ongoing Individuals
- 6333.2
- Transfers and Consumer Directed Services (CDS)
- 6333.3
- Circumstances That Necessitate a Revised Annual Service Plan (ASP)
- 6333.3.1
- Provider Transfer
- 6333.3.2
- Rate Change
- 6333.3.3
- Increase in Service Units
- 6333.3.4
- Decrease in Service Units
- 6333.4
- Annual Recertification
- 6333.5
- Ongoing CDS Monitoring
- 6333.6
- Ensuring Individual Health and Safety
- 6333.6.1
- Voluntary Suspension of the CDS Option
- 6333.6.2
- Involuntary Termination of the CDS Option
- 6333.6.3
- Re-Enrollment in the CDS Option
- 6400
- State of Texas Access Reform Plus (STAR+PLUS) Managed Care
- 6410
- Program Overview
- 6411
- Services Available Under the STAR+PLUS Option
- 6412
- STAR+PLUS Service Areas
- 6420
- STAR+PLUS Members Requesting Non-Medicaid Services
- 6430
- Transition Between DADS and STAR+PLUS
- 6430.1
- Individuals Moving Into a STAR+PLUS Area
- 6430.2
- Individuals Moving Out of a STAR+PLUS Area
- 7000
- Long Term Care Automated Systems
- 7100
- Texas Integrated Eligibility Redesign System (TIERS)
- 7110
- TIERS Inquiries
- 7200
- Determination of Financial Eligibility Based on Automated Records
- 7210
- Safeguarding Personally Identifiable Information
- 7220
- Financial Eligibility Based on Receipt of Medicaid Buy-In Program Services
- 7230
- Hierarchy of Individual Identification Data
- 7230.1
- Address Change for SSI Recipents
- 7240
- Merge and Separate
- 7300
- Service Authorization System (SAS) Wizards and Use Requirements
- 7310
- Requirement to Use SAS Wizards
- 7320
- Use of the Monitoring Wizard
- 7330
- Narrative Documentation for SAS Wizards
- 7400
- Community Services Interest List
- 7500
- CARE Access
- 7600
- Communication Tools
- 7610
- Outlook Mailboxes for Communication from Medicaid for the Elderly and People with Disabilities (MEPD)
- 7620
- Process for Notifying MEPD that a CAS Case Has Been Certified
- 8000
- Service Authorization System Help File
- 8100
- Community Care Authorizations
- 8110
- Authorizing CCAD Services Using the SAS Wizards
- 8111
- Wizard Sequencing — CCAD
- 8112
- Automatically Populated Folders by the SAS Wizards — CCAD
- 8113
- Records that Require User Entries Prior to Completing the SAS Wizard — CCAD
- 8114
- Address Folder — CCAD Services Using the SAS Wizard
- 8115
- Case Ownership — CCAD Services Using the SAS Wizard
- 8116
- Other Information — CCAD Services Using the SAS Wizard
- 8116
- Phone/Community Care — CCAD Services Using the SAS Wizard
- 8118
- Service Request/Community Care — CCAD Services Using the SAS Wizard
- 8120
- Financial Wizard
- 8120.1
- Service Request Window (Read Only) — Financial Wizard
- 8120.2
- Categorical Eligibility Window — Financial Wizard — CCAD
- 8120.3
- CAS Eligible Window — Financial Wizard — CCAD
- 8120.4
- Decline QI1 Window — Financial Wizard — CCAD
- 8120.5
- Urgent Need Window — Financial Wizard — CCAD
- 8120.6
- Potential Eligibility Window — Financial Wizard — CCAD
- 8120.7
- Couple Information Window — Financial Wizard — CCAD
- 8120.8
- Income Window — Financial Wizard — CCAD
- 8120.9
- Resources Window — Financial Wizard — CCAD
- 8120.10
- Financial Totals Window — Financial Wizard — CCAD
- 8120.11
- Financial Eligibility Summary Window — Financial Wizard — CCAD
- 8120.12
- Workers Checklist Window — Financial Wizard — CCAD
- 8130
- Functional Wizard — CCAD
- 8130.1
- Service Request Window (Read Only) — Functional Wizard
- 8130.2
- Interview Window — Functional Wizard — CCAD
- 8130.3
- Household Window — Functional Wizard — CCAD
- 8130.4
- Health Concerns Window — Functional Wizard — CCAD
- 8130.5
- Depression Details Window — Functional Wizard — CCAD
- 8130.6
- Impairment Scoring Window — Functional Wizard — CCAD
- 8130.7
- Task Purchased Details Window(s) — Functional Wizard — CCAD
- 8130.8
- Support Assisting Client Window — Functional Wizard — CCAD
- 8130.9
- Caregiver Support Details Window — Functional Wizard — CCAD
- 8130.10
- Paid Attendant Window — Functional Wizard — CCAD
- 8130.11
- Other Agency Support Details Window — Functional Wizard — CCAD
- 8130.12
- Task/Time Allocation Window — Functional Wizard — CCAD
- 8130.13
- Task/Hour Guide Summary Window — Functional Wizard — CCAD
- 8130.14
- Supervisor Window — Functional Wizard — CCAD
- 8130.15
- CCAD Attendant Hours Adjustment Window — Functional Wizard
- 8130.16
- Six Hour Window — Functional Wizard — CCAD
- 8130.17
- Home Environment Window — Functional Wizard — CCAD
- 8130.18
- Emergency Response Services Window — Functional Wizard — CCAD
- 8130.19
- Eligibility Determination Window — Functional Wizard — CCAD
- 8140
- Authorization Wizard
- 8141
- Service Request Folder — Authorization Wizard — CCAD
- 8142
- Eligibility Details Window — Authorization Wizard — CCAD
- 8143
- Service Code Selection Window — Authorization Wizard — CCAD
- 8144
- Service Arrangement Window — Authorization Wizard — CCAD
- 8145
- Provider Selection Window — Authorization Wizard — CCAD
- 8146
- Worker's BJN and Nurse's BJN Window — Authorization Wizard — CCAD
- 8147
- Information for Authorize Window — Authorization Wizard — CCAD
- 8148
- Information for Terminate Window — Authorization Wizard — CCAD
- 8149
- Authorization Summary Window (Read Only) — Authorization Wizard — CCAD
- 8150
- Nurse Authorizations Using the Wizards — CCAD
- 8151
- Service Request Window/ Draft ISP — CCAD
- 8152
- Nurse Entries to Authorize Initial DAHS or CAS Using the Wizards — CCAD
- 8160
- Changes to CCAD Authorizations Using the Wizards
- 8161
- Form 2060 Score Changes Using the Wizards — CCAD
- 8162
- Adding, Changing or Terminating Services Within Service Group 7 Using the Wizards — CCAD
- 8163
- Case Manager/Nurse Changes Using the Wizards — CCAD
- 8164
- Change in Provider Agency Using the Wizards — CCAD
- 8165
- Change in Co-Pay Using the Wizards — CCAD
- 8166
- Deleting a Registered Task Using the Wizards — CCAD
- 8167
- Increases or Decreases in the Number of Units Using the Wizards — CCAD
- 8168
- Priority Changes Using the Wizards — CCAD
- 8168.1
- Retroactive PHC and CAS Authorizations Using the Wizards — CCAD
- 8169
- Transfers from Service Group 7 to Another Service Group Using the Wizards — CCAD
- 8170
- Monitoring Wizard
- 8171
- Service Request Window — Monitoring Wizard
- 8172
- Services Authorized Window — Monitoring Wizard — CCAD
- 8173
- Contact Window — Monitoring Wizard — CCAD
- 8174
- Monitor Detail Window — Monitoring Wizard — CCAD
- 8175
- Reasons for Dissatisfaction Window — Monitoring Wizard — CCAD
- 8176
- Actions Selection Window — Monitoring Wizard — CCAD
- 8177
- Client Satisfaction Window — Monitoring Wizard — CCAD
- 8200
- Authorizing CCAD Services Without Using the Wizards
- 8200.1
- Individual — CCAD Services Without the Wizards
- 8200.2
- Address Folder — CCAD Services Without the Wizards
- 8200.3
- Authorizing Agent /Case Manager — CCAD Services Without the Wizards
- 8200.4
- Eligibility for Title XX Services — CCAD Services Without the Wizards
- 8200.5
- Enrollment — CCAD Services Without the Wizards
- 8200.6
- Location — CCAD Services Without the Wizards
- 8200.7
- Phone — CCAD Services Without the Wizards
- 8200.8
- Level of Service/Form 2060 — CCAD Services Without the Wizards
- 8210
- Adult Foster Care (AFC) Without the Wizards
- 8211
- Service Authorization — AFC Services Without the Wizards
- 8220
- Client Managed Personal Attendant Services (CMPAS) Without the Wizards
- 8221
- Authorizing Agent/Contract Manager — CMPAS Services Without the Wizards
- 8222
- Authorizing Agent/Agency — CMPAS Services Without the Wizards
- 8223
- Applied Income/Co-Pay — CMPAS Services Without the Wizards
- 8224
- Service Authorization/Agency Model — CMPAS Services Without the Wizards
- 8225
- Service Authorization/CDS Model — CMPAS Services Without the Wizards
- 8230
- Day Activity and Health Services (DAHS) Without the Wizards
- 8231
- Diagnosis — DAHS Services Without the Wizards
- 8232
- Authorizing Agent/Nurse — DAHS Services Without the Wizards
- 8233
- Authorizing Agent/Practitioner — DAHS Services Without the Wizards
- 8234
- Service Authorization — DAHS Services Without the Wizards
- 8240
- Emergency Response Services (ERS) Without the Wizards
- 8241
- Service Authorization — ERS Services Without the Wizards
- 8250
- Family Care (FC) Without the Wizards
- 8251
- Level of Service/Priority — FC Services Without the Wizards
- 8252
- Service Authorization — FC Services Without the Wizards
- 8253
- Service Item — FC
- 8260
- Meals Without the Wizards
- 8261
- Service Authorization — Meals Services Without the Wizards
- 8270
- Primary Home Care (PHC) Without the Wizards
- 8271
- Level of Service/Priority — PHC Services Without the Wizards
- 8272
- Service Item — PHC Services Without the Wizards
- 8273
- Authorizing Agent/Nurse — CAS Services Without the Wizards
- 8274
- Authorizing Agent /Practitioner — PHC Services Without the Wizards
- 8275
- Service Authorization — PHC Services Without the Wizards
- 8280
- Residential Care Services (RC or Emergency Care) Without the Wizards
- 8281
- Applied Income — RC Services Without the Wizards
- 8282
- Service Authorization — RC Services Without the Wizards
- 8290
- Special Services to Persons with Disabilities (SSPD) Without the Wizards
- 8291
- Authorizing Agent/Agency — SSPD Services Without the Wizards
- 8292
- Service Authorization — SSPD Services Without the Wizards
- 8300
- Changes to CCAD Authorizations Without the Wizards
- 8310
- Authorizing Agent Entered the Wrong Contract Number — CCAD Services Without the Wizards
- 8311
- Change in Provider Agency — CCAD Services Without the Wizards
- 8312
- Increases or Decreases in the Number of Units — CCAD Services Without the Wizards
- 8313
- Transfers from One CCAD Service to Another Without Wizards
- 8314
- Transfers from Service Group 7 to Another Service Group Without Wizards
- 8315
- Closing Nursing Facility Records Due to Transitions to the Community — CCAD Services Without the Wizards
- 8400
- Draft Functionality in CCAD Wizards
- 8410
- Storing a Case in Draft — CCAD
- 8411
- Accessing a Case Stored in Draft — CCAD
- 8500
- CCAD Information
- 8510
- Financial Information — CCAD
- 8520
- Authorization Information — CCAD
- 8530
- Functional Information — CCAD
- 8540
- Monitoring Information — CCAD
- 8600
- CCAD Forms Directory
- 8700
- In-Home and Family Support Program (IHFSP) Without the Wizards
- 8710
- Authorizing Agent — IHFSP Services Without the Wizards
- 8711
- Enrollment — IHFSP Services Without the Wizards
- 8712
- Service Plan — IHFSP Services Without the Wizards
- 8713
- Changes in SAS — IHFSP Services Without the Wizards
- 8714
- Increase in Service Plan Amount — IHFSP Services Without the Wizards
- 8715
- Service Authorization — IHFSP Services Without the Wizards
- 8716
- Six Month Review — IHFSP Services Without the Wizards
- 8717
- Annual Review and Recertification — IHFSP Services Without the Wizards
- 8720
- Termination — IHFSP Services Without the Wizards
- 8721
- Terminations Where IHFSP is the Only Service — Services Without the Wizards
- 8722
- Terminations Where IHFSP is with Other Services — Services Without the Wizards