Texas Home Living (TxHmL)
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How to become a TxHmL provider
The Texas Department of Aging and Disability Services (DADS) screens, enrolls and certifies Texas Home Living (TxHmL) program provider applicants for compliance with state and federal laws and regulations.
In accordance with Texas Administrative Code, Title 40, Part 1, Chapter 9, Subchapter Q, §9.704, TxHmL program provider applicants are required to complete a Pre-Application Orientation (PAO) before submitting an application packet to DADS.
TxHmL program provider applicants are required to:
- successfully complete the Pre-Application Orientation (PAO)
- properly complete the application packet and include all required documents in accordance with DADS' instructions.
The deadline for the PAO is Oct. 31, 2012.
Application packet information
| Applications packets must be sent to: | |
|---|---|
| Regular mail DADS Community Services Contracts Unit Mail Code W-517 P.O. Box 149030 Austin, Texas 78714-9030 |
Overnight delivery DADS Community Services Contracts Unit Mail Code W-517 701 West 51st St. Austin, Texas 78751 |
Note To All TxHmL Applicants: Please do not submit applications within binders or cover sheets. Each application page needs to be date stamped for date of receipt.
DADS requires, in accordance with 40 TAC §9.705 (c), application packets to be submitted with in 45 days following the completion of all PAO requirements.
DADS Form 5873, HCS/TxHmL Waiver Program Application Packet Checklist, includes all required forms and documents of an application packet. Program provider applicants should use this as a guide and final checklist to ensure their application packets are complete.
Applicants should remember to:
- Read all instructions carefully.
- Use the application packet checklist (Form 5873) as a guide.
- Answer all the questions on each required form.
- Have the signature authority — the owner or authorized representative of the legal entity — sign and date each form (an authorized representative is the person named on DADS Form 2031, Governing Authority Resolution - Business Organization).
- Have the applicable forms notarized.
- Complete each required form accurately in accordance with DADS' instructions.
- Not use correction tape or fluid. (If a mistake is made, mark through it with a single line and initial the change.)
- Review the completed application packet.
- Retain a copy of the completed application packet.
- Submit the entire application packet and all required documentation to DADS by the deadline.
Click here to read the Texas Administrative Code, Title 40, Part 1, Chapter 9, Subchapter Q, §9.705 (e) as it relates to program provider application packets.
DADS may automatically reject an application packet if:
- Social Security card is not signed.
- Legal entity name does not match verification documents.
- Forms or other required documentation is missing or illegible.
- Application packet is submitted late.
- Application packet does not contain original signatures and/or dates on required forms.
- Forms are not notarized when required.
- Correction fluid/tape is used.
- Application packet contains more than five errors.
- Resume of program manager does not reflect:
- minimum of three years of work experience in planning and providing direct services to people with intellectual disabilities;
- places of employment; and
- month and year of employment.
- Each letter of reference for program manager:
- does not professionally attest to the minimum of three years of work experience in planning and providing direct services to people with intellectual disabilities as documented in the resume;
- is not signed; and
- is not verifiable by address or phone number.
Required forms
The following forms should be completed in accordance with DADS' instructions. Please do not send instructions or blank/unused form pages with an application packet. If any of the required forms are missing, DADS will reject the application packet, in accordance with 40 TAC §9.705 (e).
Unless indicated otherwise, all of the following forms and documents must be submitted regardless of the type of community service provided.
- Copy of National Provider Identifier (NPI) notification letter (Not required for non-healthcare services)
- Copy of required license(s), if applicable
- Form 2031, Governing Authority Resolution, Business Organization
- Form 3681, Community Services Contract Application
- Form 3691-A, Service Area Designation [For Home and Community-based Services (HCS), Texas Home Living (TxHmL), Consumer Directed Services (CDS) and Transition Assistance Services (TAS) in lieu of Form 3691]
- Form 4732, Nongovernmental Contractor Certification
- Form 4732-A, Nongovernmental Contractor Certification (Part II), if applicable
- Form 5871, Disclosure of Ownership and Control Interest Statement
- Form 5871-S, Disclosure of Ownership and Control Statement – Short Form
In addition to the forms and documents listed above, the following forms must be completed and submitted for the Community Services programs indicated
- DADS Form 5873, HCS/TxHmL Waiver Program Application Packet Checklist
- DADS Form 5875, HCS Waiver Program Self-Assessment Certification (if applying to become an Home and Community-based Services provider)
- DADS Form 5920, TxHmL Waiver Program Self-Assessment Certification (if applying to become a TxHmL provider)
Required documents
The following documents must be completed and submitted with the application packet in accordance with DADS' instructions:
- A copy of National Provider Identifier (NPI) verification email or letter.
- The program manager's resume.
- This individual is indicated in Section 7b of Form 3681 and will be attending and taking the exam(s) at the DADS Provider Applicant Training, if the application packet is accepted.
- The resume must reflect:
- a minimum of three years of work experience in planning and providing direct services to people with intellectual disabilities;
- places of employment; and
- month and year of employment.
- Three letters of reference for the program manager.
- Each reference letter must:
- professionally attest to the minimum of three years of work experience in planning and providing direct services to people with intellectual disabilities as documented in the resume;
- be signed; and
- be verifiable by address or phone number.
- Each reference letter must:
- Copies of PAO certificates of completion:
- must include copies for each individual who is required to complete the PAO;
- must include a copy for all six modules;
- must be signed by the individual completing the PAO; and
- must have a score of 70 percent or higher for each module.
- Copies of receipts for criminal history records requests:
- must show fingerprinting transaction occurred on or before 45 days after completing the PAO; and
- must be submitted for all required individuals.
- Copy of Assumed Name Certificate, if applicable.
Required legal entity documents
Criminal history records requests
DADS requires an TxHmL provider program applicant to submit criminal history record information in accordance with 42 Code of the Federal Regulations (CFR) §455.106. To comply with this requirement, DADS must receive criminal history record information from the Texas Department of Public Safety (DPS) for each individual described below.
Program provider applicants must disclose criminal history record information for all individuals with an ownership or control interest. A person with an ownership or control interest means a person or corporation who:
- has direct or indirect ownership interest equal to or totaling 5 percent or more in the disclosing entity;
- has a combination of direct and indirect ownership interests equal to 5 percent or more in the disclosing entity;
- owns an interest of 5 percent or more in any mortgage, deed of trust, note or other obligation secured by the disclosing entity if that interest equals at least 5 percent of the value of the property or assets of the disclosing entity;
- is an agent, officer, director or managing employee of an applicant that is organized as a corporation; or
- is an agent, officer, director or managing employee of an applicant that is organized as partnership.
- An "agent" is defined as an individual who has been delegated the authority to obligate or act on behalf of an applicant.
- A "managing employee" or "director" is defined as a general manager, business manager, administrator, director, program manager or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of the disclosing entity.
- An "officer" is defined as an individual who is a member of the disclosing entity's board of directors such as the president, secretary, treasurer or board member.
DPS has entered into an exclusive contract with L-1 Enrollment Services to provide statewide electronic fingerprinting for criminal history record requests. Individuals will need to schedule an appointment at a Fingerprint Applicant Services of Texas (FAST) location to complete their criminal history record request. Once fingerprinting has been completed, FAST will electronically send the request to DPS which will in turn send the results to DADS, as requested by the individual.
Please note that there are fees associated with acquiring criminal history records. In addition, DPS will not expedite last minute requests for criminal history record information. All criminal history records requests must be completed within 45 days of completing the PAO.
The easiest way to complete this requirement is to schedule an appointment online Fingerprint Applicant Services of Texas (FAST). Appointments can also be scheduled by phone at 1-888-467-2080. A list of all FAST locations in Texas and their hours can be found online. The cost of this service is $9.95 plus a $15 fee for the criminal history.
Instructions to schedule an appointment online
Please note that when scheduling your appointment, you will be asked where the results of your criminal history record request should be sent. DADS requests that all criminal history record requests be sent to:
DADS
ATTN: Geraldine Taylor
Mail Code W-517
P.O. Box 149030
Austin, Texas 78714
DADS may require an applicant to provide additional information regarding the certification of criminal history information. Furthermore, DADS may reject a contract application packet based on:
- the results of the criminal history record information submitted; and
- an applicant's failure to comply with the requirements.
NOTE: DADS, at its discretion, may reject an application if the applicant or any person with an ownership or control interest in the applicant, or an agent or managing employee of the applicant has been convicted of any criminal offense listed in the Texas Administrative Code, Title 1, Part 15, Chapter 371, Subchapter G, Division 4, §371.1685.
National Provider Identifier (NPI)
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that each health care entity use an assigned National Provider Identifiers on standard health care transactions. Therefore, as of Dec. 1, 2006, DADS has required all health care entities applying to contract with DADS to obtain and report their NPI in order to comply with this HIPAA requirement.
An applicant must submit an NPI assignment letter or an -mail from the National Plan and Provider Enumeration System (NPPES), to DADS verifying the NPI that corresponds with the legal entity of the applicant. The NPPES verification must be submitted to DADS along with the application packet.
The NPI is a nationally recognized ten digit number that is used to identify healthcare providers when conducting standard transactions with multiple health plans. The National Plan and Provider Enumeration System (NPPES) issues NPI(s) at the direction of the Centers for Medicare and Medicaid Services (CMS). HIPAA requires all healthcare providers to apply for an NPI. A healthcare provider is someone who provides health care services. An example of health care services includes professional therapies, nursing services, dental or physician services. NPI(s) are not automatically assigned; there is an application process.
The NPI application process
- The online application and instructions are available at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.
- The application is available for download at: http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.
- Taxonomy codes are available online at http://www.wpc-edi.com/codes/taxonomy. The taxonomy codes for the majority of DADS providers are found in the Non-individual section of the Health Care Provider Taxonomy guide. Select the taxonomy that best describes your business.
- For application help please visit: https://nppes.cms.hhs.gov/NPPES/Help.do.
Medicaid provider enrollment
All providers performing medical services who wish to be eligible for reimbursement for Title XIX (Medicaid) benefits must complete the required Medicaid Provider Enrollment Application forms and, if applicable, enter into a written provider agreement. For information on how to become a Medicaid provider, please visit the Texas Health and Human Services Commission website.
Updated: May 17, 2012