Effective Date
Instructions
Updated: 11/2025
Purpose
The local intellectual and developmental disability authority (LIDDA) uses Form 1055 to submit the State Supported Living Center (SSLC) Transition Reports for people transitioning out of the SSLC. The LIDDA Handbook Section 9500, Post Enrollment in HCS as an SSLC Transition, discusses these requirements for reporting. The LIDDA prepares Form 1055 on a quarterly basis for each person transitioning out of an SSLC. They submit to the IDD Money Follows the Person Unit following the name convention listed below:
When submitting a person’s SSLC transition report, the LIDDA must provide each person’s required information in separate PDF attachments. The LIDDA must name each submission with the following file naming convention:
- the person’s last initials
- the person’s first initials
- fiscal year (FYXX)
- quarter (QtrX)
- the date of the submission, May 1, 2022=05012022
Example: SBFY22Qtr2-05012022
Once the form is complete, submit it to the transitioning SSLC and the Home and Community-based Services (HCS) provider before submitting to:
LIDDA Connect under the appropriate LIDDA folder. Pathway: File Sharing Interface>Your LIDDA>MFP>SSLC Monitoring.
Submit all questions about reports to IDDMFPSupport@hhs.texas.gov.
If you experience any issues logging into your LIDDA Connect account or have any questions or concerns, email liddaconnect@hhs.texas.gov.
If the correct items are not attached or in the correct format, the MFP Oversight Specialist will email back to remind the LIDDA of the protocol and ask them to resend based on the correct process.
Before Entering Information on the Form
Before entering information on the form, you must:
- use save as to rename the file
- close the file
- open the renamed file
Detailed Instructions
Person’s Name — Enter the name of the person who transitioned.
Client Assignment and Registration (CARE) System ID — Enter the person’s CARE ID.
Transition from SSLC Date — Use the drop-down menu to enter the date the person transitioned.
SSLC Transitioned from — Use the drop-down menu to select the name of the SSLC the person transitioned from.
Monitoring Year — Select the year from the drop-down menu that corresponds to the year of monitoring being submitted. This is based on the year the person transitioned. Example: Person transitioned to the community on Jan. 5, 2023. Their first year would go until Jan. 4, 2024, and their second year would begin Jan. 5, 2024.
90-Day Period — Select the 90-day period from the drop-down menu that corresponds to the period being submitted for the current year. Each person’s 90-day period will depend on their transition date. Example: Person transitioned to the community on Jan. 5, 2023. Their first 90 days will end on April 5, 2023, and the report submitted will indicate first 90 days.
Community Transition Information
Current LIDDA Name — Enter the name of the LIDDA completing the form.
Component Code — Enter the component code for the LIDDA completing the form.
Did a Transfer Between LIDDAs Occur During the Quarter? — Check Yes or No.
Transferring LIDDA — Enter the name of the LIDDA who completed the transfer to the current LIDDA, if answered yes to a transfer. Otherwise, put NA.
Receiving LIDDA — Enter the name of the current LIDDA who received the transfer, if answered yes to a transfer. Otherwise, put NA.
Effective Transfer Date — Use the drop-down menu to enter the date the transfer was effective, if answered yes to a transfer. Otherwise, leave blank.
Program Person Transitioned to — Check the appropriate box to indicate which program the person is currently in. If Other is checked, provide the program name or where the person went.
HCS Residential Type, if applicable — If the person is in HCS, type in the residential type they are currently in. If the person is not in HCS, put NA.
Post-move Monitoring – This is where the LIDDA documents the three post-move visits that occur during the first 90 days after transition.
Post-move Monitoring Visits — Check the appropriate box to indicate which of the three post-move monitoring visits is being documented. Enter the date of the visit next to the box that was checked. Check NA if a post-move monitoring visit did not occur during the reporting period.
Essential, Pre-move Supports — Enter each pre-move support listed on the Community Living Discharge Plan (CLDP). These are the essential supports which must be in place before the move-in date. For each support listed, check Yes or No to indicate if the support continues to be in place. If No is checked for any pre-move support, explain the provider’s justification for discontinuing the support, if there was an adverse impact on the person, and if so, what steps the service coordinator has taken to resolve the issue.
Questions — For Questions 1-18 check appropriate boxes and provide detailed answers in the space provided as applicable.
Additional Comments — Describe any other pertinent information or events that took place during the quarter here.
SSLC Staff Name and SSLC Name — Enter the name of the SSLC staff who received the report and the SSLC name.
Provider Staff Name and Program Provider Agency — Enter the name of the provider staff who received the report and the designated provider agency name.
Printed Name of Service Coordinator — Enter the name of the enhanced community coordinator or service coordinator assigned who completed the monitoring visits for the quarter and completed this transition reporting form.
Service Coordinator’s Signature — The assigned enhanced community coordinator or service coordinator who completed the form should sign to attest that the information above is correct.
Date — List the date the enhanced community coordinator or service coordinator signed the form.
Printed Name of Supervisor — Enter the name of the enhanced community coordinator’s or service coordinator’s supervisor who reviewed the form.
Supervisor’s Signature — The assigned supervisor should sign to attest that they have reviewed the form and all information is correct.
Date — List the date the supervisor signed the form.