Case Manager In-Home and Family Support Program Handbook

1000
Program Description
1100
Background
1200
Mission of the Program
1300
Principles of the Program
2000
Intake and Interest List
2100
Service Request
2110
Requests for Services
2120
Caregiver Support Data Collection
2200
Interest List Procedures
2210
Interest List Placement
2211
Interest List Monitoring
2212
Adding Individuals Back to the Interest List
2213
Earliest Date for Adding an Individual Back to the Interest List
2214
Special Exception to Interest List Placement
3000
Application
3100
Initial Case Assignment
3110
Conflict of Interest Between Case Manager and Applicant or Individual
3120
Initial Interview
3121
Applicant Attendance at the Interview
3122
Interview Process
3123
Forms Required at the Initial Interview
3200
Application Processing
3210
Good Faith Effort
3300
Voter Registration
4000
Eligibility
4100
Introduction to Eligibility Determination
4200
Income Eligibility
4210
Income Types
4211
Earned and Unearned Income
4212
Lump-Sum Payments
4213
Exempt Income
4220
Income Verification
4221
Exemptions from Income Verification
4230
Calculation of Countable Income
4240
Changes in Income
4241
Changes in Earned Income
4242
Changes in Unearned Income
4300
Functional Eligibility
4310
Functional Eligibility Criteria
4311
Medical Practitioner's Recommendation
4312
Disabilities Screening Instrument
4320
Eligibility for Individuals Who Have a Psychiatric Diagnosis
4321
Procedures for Eligibility Determination for Individuals with a Psychiatric Diagnosis
4400
Other Eligibility Requirements
4410
Age
4420
Residency
4430
Participant Agreement
4440
Receipt of Other DADS Services
4441
Procedures Regarding Particular Medicaid Waiver Programs
4441.1
Mutually Exclusive with PACE
4442
Eligibility in Managed Care Areas
4443
Refusal to Accept Interest List Placement
4450
Child Support Delinquency
5000
Program Benefits
5100
Categories of Program Benefits
5110
Subsidy Grants
5111
Notes Regarding Allowable Services
5112
Items and Services Not Allowed
5113
Public School and Parental Responsibilities
5200
Estimating Grant Amounts
5210
Service Subsidy Estimates
5220
Transportation Estimates
5230
Bid Procedures
5300
Architectural Modifications
5400
Requests for Purchased Items and Services
5410
Required Documentation
5411
Prescription Medication
5412
Dental Services
5413
Other Items and Services
5420
Items Not Needing State Office Approval
6000
Service Plan
6100
Service Plan Development
6110
Documentation
6111
Documentation of Prescribed Medications
6120
Narrative Attachment
6130
Forms
6140
Certification for Benefits
6200
Ongoing Service Planning
6210
Six-Month Review
6211
Receipt Procedures — Six-Month Review
6212
Service Plan Documentation
6213
Narrative Documentation
6214
Documentation of Six-Month Review
6220
Annual Recertification
6221
Receipt Procedures — Annual Recertification
6222
Service Plan Documentation
6223
Narrative Documentation
6224
Income Verification
6224.1
Exceptions to Income Verification Requirements at Annual Recertification (for Unearned Income Only)
6225
Other Services
6226
Documentation of Annual Recertification
6230
Service Plan Changes
6240
Computation of Service Subsidy Grants
6300
Service Plan Items Potentially Covered by Other Programs
6400
Referral to Other Programs
6410
Refusal to Accept Interest List Placement
6500
Services Provided by the Individual's Natural Support System
6600
Coordination with Other Programs
6610
Communication with Non-DADS Programs
6611
SNAP, TANF and TANF-Related Medicaid Households
6612
TANF and TANF-Related Medicaid Households
6613
SNAP
6614
SSI and SSI-Related Medical Assistance Only
6615
Medical Assistance Only
6616
Individuals Receiving SSI Only
6617
Safeguarding Resource Eligibility for TW, SSI and MAO Recipients
6618
Reimbursement for Future Expenses
6620
Communication with Other DADS Programs
6700
Reduction or Termination of Benefits
6710
Suspension of Benefits when an Individual Enters a Nursing Facility
6711
Six-Month Review While Individual is Residing in a Nursing Facility
6712
Annual Recertification While Individual is Residing in a Nursing Facility
6713
Service Authorization System Entries Required Upon Discharge from Facility
6714
Termination for NF Stays Exceeding Six Months
6720
Suspension of Benefits When an Individual Enters a Medical Facility
6730
When an Individual Moves Out of State
6740
Death of an Individual
6750
Unable to Locate Individual
7000
Payment System
7100
Texas Identification Number
7200
Purchase Voucher
7210
Completion of Form 4116
7211
Electronic Submission to DADS Accounts Payable Unit
7212
Completing a Change of Address or Other Information
7300
Unusual Situations
7310
Replacement of Lost Program Funds
7320
Withheld Warrants
7321
Warrants Held for Delinquent Student Loans
7322
Warrants Held for Delinquent State Taxes
7323
Warrants Held for Delinquent Child Support Payments
7324
Warrants Held for Overpayment of Unemployment Benefits
8000
Receipt Policy
8100
What Constitutes an Acceptable Receipt
8110
Purpose of Obtaining Receipts
8111
Acceptable Vendor Identifying Information on IHFSP Receipts
8111.1
Dates of Service Outside the Current Six-Month Period
8112
Prescription Receipts
8113
Transportation, Room and Board
8200
Receipt Procedures for Medical Services Covered by Partial Medicare Reimbursements
8300
When Receipts are Not Provided
8310
Repayment
8320
Spend Down
8321
Service Authorization System Actions Related to Spend Down
8321.1
Spend Down at the Six-Month Review
8321.2
Spend Down at Recertification
8330
Loss of Receipts
9000
Notification and Appeals
9100
Confidential Information on Notifications
9200
Notification of Eligibility Status
9300
Notification of Adverse Actions
9400
Fair Hearing Process
9410
Receipt of the Request for a Fair Hearing
9411
Continued Benefits When Program Eligibility is Denied
9420
Preparation for the Fair Hearing
9430
Regional Responsibilities
9431
Presentation of the Evidence
9440
Post-Hearing Actions
9441
Fair Hearings Exception Process
10000
Miscellaneous
10100
Confidential Nature of the Case Record
10200
Correcting Information
10300
Establishing Identity for Contact Outside the Interview Process
10310
Telephone Contact
10320
In-Person Contact
10330
Verification and Documentation
10400
Safeguarding Personally Identifiable Information
10500
Alternate Means of Communication
10600
Custody of Records
10700
Disposal of Records
10800
When and What Information May Be Disclosed
10810
Confidentiality of Medical Information and HIPAA
10811
Privacy Notice
10812
Individual Authorization
10820
Minimum Necessary
10830
Requests for Information Related to a Deceased Individual
10840
Personal Representatives
10841
Adults and Emancipated Minors
10842
Unemancipated Minors
10843
Deceased Individuals
11000
Service Authorization System Help File
11100
In-Home and Family Support Program – Service Group 7
11200
Searching for an Individual
11300
Existing Individual Information
11400
No Individual Information Found
11500
Creating a New Individual in SAS – IHFSP
11600
Using an Existing Individual Record in SAS
11610
Address – IHFSP
11620
Phone – IHFSP
11630
Submitting the IHFSP Record
11640
Authorizing Agent – IHFSP
11650
Eligibility – IHFSP
11660
Enrollment – IHFSP
11670
Service Plan – IHFSP
11680
Service Authorization – IHFSP
11690
Submitting Plan – IHFSP
11700
IHFSP Changes in SAS
11710
IHFSP Change – Six-Month Review
11720
Annual Recertification – IHFSP
11730
IHFSP Change – Individual in a Nursing Facility at the Time of Recertification
11740
IHFSP Change – Individual in a Nursing Facility for Temporary Stay
11750
IHFSP Change – SAS Actions When an Individual Returns to the Community Before the Receipt Due Date
11760
IHFSP Change – SAS Actions When an Individual Returns to the Community After the Receipt Due Date
11800
Terminations – IHFSP
11810
Terminations – IHFSP Only
11820
Terminations – IHFSP With Other Services
11900
Spend Down
11910
Spend Down – Six-Month Review
11920
Spend Down – Recertification Review
11930
Spend Down Resolved