D-1000 Intake and Assessment for Services

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D-1010 Overview

Revision 21-0; Effective January 15, 2021

Area Agencies on Aging (AAAs) and subrecipients must ensure compliance with eligibility, reporting, and other requirements of the Older American Act (OAA) and the Texas Health and Human Services Commission (HHSC). This section provides information about forms and processes used for intake, and assessments required for specific services.

D-1020 Intake

Revision 25-1; Effective January 31, 2025

An intake is the initial contact with a person. It helps identify the person's potential needs and collect information to determine eligibility and coordinate appropriate services. Information includes the person’s demographic and contact information and other information needed for the coordination of services and data required for the State Program Report (SPR).

The intake also documents eligibility for nutrition services for a person under 60 years old, such as the spouse of an eligible person who receives a meal.

Use the information collected during the intake process to determine priority populations and ensure preference is given to OAA targeted populations without excluding others from participating in a service when possible.

The low, moderate, and high-income information, collected at intake, also helps identify target populations, inform outreach strategies, and allows HHSC to report on the number of people with income below poverty level receiving certain services, such as:

  • care coordination;
  • chore maintenance;
  • day activity and health services;
  • home delivered meals;
  • homemaker; and
  • personal assistance.

Complete Form 2276, Intake, before service authorization for each new person requesting services.

Form 2276 captures the following information:

  • indication that the Client Rights and Responsibilities and Release of Information were explained;
  • date of intake;
  • last name, middle initial and first name;
  • sex;
  • date of birth;
  • home address:
    • city;
    • state; and
    • ZIP code;
  • county;
  • phone number;
  • ethnicity;
  • race;
  • if the person lives alone;
  • if the person is in poverty; and
  • the reason for eligibility for nutrition services for person under 60.

Use Unknown, Not Reported or Don’t Know for any field on the Form 2276 only if a person refuses to provide the information.

The intake process must be flexible and adapt to the needs of:

  • a homebound person;
  • a patient waiting hospital discharge;
  • people of widely varying ethnic and cultural characteristics;
  • people who speak languages other than English; and
  • people with widely varying disabilities. 

Face-to-face contact with the person requesting a service is not required during the intake process. The intake may be conducted with a caregiver or authorized representative. The name of the staff member completing Form 2276 is required, but not their signature.

Additional information may be collected during the intake to meet agency specific business requirements.

Completion of Form 2276 is not required for Information, referral and assistance services.

Documentation

Documentation must include the name of the AAA or service provider, the date completed, and the name of the person completing Form 2276. Complete all required information for every person receiving a service.

Reporting

Report required information using HHSC's information management system at initial intake and for periodic updates.

Related Policy

Eligibility, F-1120
Eligibility, F-1220

D-1030 Caregiver Intake

Revision 25-1; Effective January 31, 2025

Screen each person requesting Caregiver Support to document eligibility and collect data required for the SPR.

Complete Form 2270, Caregiver Intake, before service authorization for each new person requesting caregiver support services.

Form 2270 captures the same information as the standard intake and additional information required for caregiver services, including:

  • relationship to care recipient(s) who is 60 years or older;
  • relationship to care recipient(s) who is 18 years or younger and the caregiver is 55 years or older and is an older relative caregiver;
  • relationship to care recipient(s) who is 18 to 59 years with a disability and caregiver is 55 years or older and is an older relative caregiver;
  • care recipient’s date of birth; and
  • name, date of birth, sex and relationship to caregiver for each child cared for by an older relative caregiver.

Use Unknown, Not Reported or Don’t Know for any field on the Form 2270 only if a person refuses to provide the information.

The name of the staff member completing Form 2270 is required, but not their signature.

Additional information may be collected during the intake to meet agency specific business requirements.

Completion of Form 2270 is not required for Information, referral and assistance services. 

Documentation

Documentation must include the name of the AAA or service provider, the date completed, and the name of the person completing Form 2270. Complete all required information for every person receiving a service.

Reporting

Report required information using HHSC’s information management system at initial intake and for periodic updates.

Related Policy

Home Delivered Meals for Caregivers, F-1230

D-1040 Consumer Needs Evaluation

Revision Notice 26-2; Effective April 8, 2026

The Consumer Needs Evaluation CNE (PDF) form documents a person’s need for:

  • care coordination;
  • caregiver respite;
  • chore maintenance;
  • day activity and health services;
  • emergency response;
  • home delivered meals (HDMs);
  • homemaker;
  • personal assistance; and 
  • residential repair. 

Complete the CNE form to determine a person’s functional impairments and eligibility to receive services. The CNE also collects necessary Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) information required for the State Performance Report. Do not alter the content of the required CNE form.

After the initial assessment, complete CNE reassessments annually. Complete the reassessment sooner if there is a significant change in the person’s condition.  

Significant changes requiring a reassessment include a:

  • change in functional status such as an accident, illness or hospitalization;
  • change in living situation;
  • change in the caregiver relationship;
  • loss, damage, or deterioration of the home living environment;
  • loss of a spouse, family member or close friend; or
  • loss of income.

An impairment in ADLs is the inability to perform one or more of the following six ADLs without personal assistance, stand-by assistance, supervision or cues:

  • eating;
  • dressing;
  • bathing;
  • toileting;
  • transferring in and out of bed or chair; or
  • walking.

An impairment in IADLs is the inability to perform one or more of the following seven IADLs without personal assistance, stand-by assistance, supervision or cues:

  • preparing meals;
  • shopping for personal items;
  • managing medication;
  • managing money;
  • using the phone;
  • doing light or heavy housework; or
  • transportation ability which refers to the person’s ability to use available transportation without help.

Conduct the CNE assessment and reassessment face-to-face or by phone.

To qualify for an HDM, a person must have a minimum score of 20 on the CNE form. Refer people who do not meet the score of 20 to the congregate nutrition program, when available.

If a caregiver provides help to an older person, the care recipient must be frail to qualify for respite care and supplemental services funded by Title III-E. Frail means the care recipient:

  • cannot perform a minimum of two ADLs; or
  • requires a great deal of supervision due to cognitive or other mental impairment which may cause the person to pose a serious health or safety hazard to self or another person.

The CNE form and instructions are on the HHSC AAA website. Do not alter this required form.

Documentation

Documentation includes the name of the:

  • Area Agency on Aging (AAA) or subrecipient;
  • person conducting the CNE assessment; 
  • the date completed; and
  • person assessed. 

Answer all questions for every person receiving service.

Reporting

Report responses for the CNE form using HHSC's information management system at initial assessment and all reassessments.

Related Policy

Eligibility, F-1220

D-1050 Caregiver Assessment Questionnaire

Revision Notice 26-2; Effective April 8, 2026

The Caregiver Assessment Questionnaire CAQ (PDF) documents a caregiver’s needs and identifies:

  • possible barriers to carrying out caregiver responsibilities;
  • existing resources and supports for the caregiver; and
  • the level of caregiver stress.

Complete the initial assessment at intake for all caregivers receiving caregiver support coordination funded through Title III-E of the OAA. After an initial assessment, complete an annual reassessment..

A CAQ may be completed through a face-to-face interview or by phone. Staff must discuss the questions with the caregiver. The results of the assessment inform the type of services the caregiver needs.

Documentation

Documentation must include the name of the person conducting the CAQ assessment, the date completed, and the name of the person assessed. Answer all questions for every person receiving caregiver support coordination service.

Reporting

AAAs and subrecipients must report responses for the CAQ form. AAAs use the HHSC information management system to report the initial assessment. AAAs and subrecipients also report all subsequent reassessments.

Related Policy

Caregiver Intake, D-1030

D-1060 Nutritional Risk Assessment

Revision Notice 26-2; Effective April 8, 2026

Complete a nutritional risk assessment annually for every person receiving congregate meals, HDMs or nutrition counseling. 

HHSC uses the DETERMINE Your Nutritional Health checklist as the nutritional risk assessment tool. The DETERMINE Your Nutritional Health checklist:

  • is a nutrition screening tool used to identify people at risk of poor nutritional health or those with malnutrition;
  • must be completed at intake for all people receiving congregate meals, HDMs or nutrition counseling;
  • serves as the required annual nutrition risk reassessment; and
  • cannot be altered.

People at high nutritional risk are those who score six or higher on the DETERMINE Your Nutritional Health checklist. Use the checklist to measure a person’s change in level of nutritional risk over time and assess the need for nutrition counseling. Overall nutritional scores help evaluate the effectiveness of the nutrition program and trends inform topics for future nutrition education events.

The person requesting congregate or HDMs can complete the DETERMINE Your Nutritional Health checklist. Staff can complete the checklist through an interview with the person, if needed.

After the assessment, provide the person with a copy of Form 2272, Determine Your Nutritional Health Handout with the date of the screening and the assessment score. If conducting the assessment by phone, provide both the completed checklist and handout by mail to the person assessed.

Documentation

Documentation must include the name of the AAA or subrecipient, the name of the person screened, and the date completed. Answer all questions for every person receiving meals.

Reporting

Report responses for the DETERMINE Your Nutritional Health checklist using HHSC’s information management system for the initial assessment and all reassessments.

Related Policy

Intake, D-1020
Caregiver Intake, D-1030
Eligibility, F-1120
Eligibility, F-1220

D-1070 Determination of Type of Meal – Home Delivered Meals

Revision Notice 26-2; Effective April 8, 2026

The Determination of Type of Meal (DTM) assessment makes sure certain meals are right for a person. Meals served daily should be consumed the same day the meal is delivered. Conduct the DTM assessment by phone or face-to-face, in the eligible person’s home. Do not alter the content of the required form.

Complete the DTM assessment before the person receives several meals in one delivery. These meals consist of chilled, shelf-stable or frozen, or in any other condition that lets a person eat the meal at a time other than the day of delivery. 

An annual DTM is required. An earlier DTM may be needed if circumstances indicate a significant change in the person’s condition per the meal provider’s written policy.

The person receiving several meals to be eaten after the day of delivery must be able to eat meals independently or with available help. The person must be able to handle, store, prepare and otherwise manage the meal delivery, as well as manage the daily meal, when multiple or bulk meals are being delivered.

Consider the person’s capability, home environment, literacy, cognition, language, caregiver support and other factors to ensure the person’s health and safety. The person may not receive multiple meals in one delivery if the evaluation shows a barrier exists and cannot be remedied.

The DTM evaluates areas such as:

  • Home equipment: The person who receives the meals has working equipment and utilities in the home. These include:
    • gas;
    • electricity;
    • a stove with a working oven;
    • a working microwave oven;
    • a working toaster oven; and
    • a working refrigerator or a freezer.
  • Ability to follow instructions: Consider a person’s ability to follow instructions to safely store and prepare meals or have a caregiver capable of following instructions. The inability to follow instructions can be related to literacy, language, vision or cognition.
  • Ability to physically manage meals: Consider a person’s ability to physically manage meals or  have a caregiver physically manage meals for them. Manual dexterity and fine motor skills may impair a person’s ability to open, store and prepare meals and overall strength. Evaluate balance and mobility.
  • Ability to eat meals: Consider a person’s ability to eat a specific type of meal before they discontinue hot meals and other meals served on a regular basis. A dental or medical condition that might compromise the ability of the person to consume meals and makes it difficult to eat certain types of foods such as:
    • hard foods such as raw vegetables and nuts;
    • nut butters such as peanut butter; 
    • fibrous proteins such as pork chops or steak; or 
    • other foods such as granola bars and raisins.
  • Identification of caregiver: Identify a caregiver who can and will help manage the meals, including:
    • receive and accept the meals;
    • unpack and store the meals; and
    • preparing the meals as appropriate.                                                                      

The AAA or subrecipient may deny or terminate frozen, chilled, or shelf-stable meals based on the results of the DTM. They may also deny or terminate if an eligible person refuses to discuss or allow a visual observation of the intended home environment where they will deliver appropriate meals.

The AAA or subrecipient must try to remedy barriers to service. This includes referrals to local community resources to coordinate resources such as residential repair, health maintenance, or other services.

The AAA or subrecipient may not terminate nutrition services to an eligible person. This includes hot meals, because a person cannot manage other types of meals based on the results of the DTM assessment. If a person cannot manage frozen, chilled or shelf-stable meals, and does not have another person to help, it may mean that the person is frail or isolated. These are targeted populations under the OAA.

If an AAA or subrecipient considers stopping hot meals for an entire area or route and replacing them with chilled, frozen, shelf-stable or multiple meals, they must determine the impact to the people served using the DTM assessment. If they determine a person is too frail or cannot manage the type of replacement meal considered, the AAA or subrecipient must:

  • continue hot meals;
  • identify if the person has someone available who can manage the meals for them; or
  • help the person access other in-home services before discontinuing daily hot meals.

Federal law mandates providers must target in-home services to frail, homebound or isolated people. HDMs are an in-home service.

Documentation

Documentation must include the name of the AAA or subrecipient,  date completed, name of the person conducting the evaluation, name of the person requesting HDMs, and type of meals requested.

The AAA or subrecipient must maintain the results of each evaluation to determinate the appropriateness of a meal to an eligible person.
The meal provider must document:

  • the date of denial;
  • the reason for the denial; and 
  • how they notified the person of the denial when a person is not eligible to receive a meal, based on the DTM.

Document the efforts by the meal provider to remedy barriers to service. Include referrals to local community resources to coordinate resources such as residential repair, health maintenance, or other services, in the eligible person’s file.

Reporting

AAAs and subrecipients must report responses for the DTM using the HHSC information management system for the initial assessment and all reassessments.

Related Policy

Eligibility, F-1220