Effective Date
Instructions
Update: 3/2026
Purpose
Local intellectual and developmental disability authority (LIDDA) staff use Form 1094 to submit a request for authorization of LIDDA specialized services to the Texas Health and Human Services Commission (HHSC).
Submission
Within 3 business days after the initial interdisciplinary team (IDT) meeting or Service Planning Team (SPT) meeting, the habilitation coordinator submits this form and Form 1013, PASRR Plan of Care, to the LIDDA Connect SharePoint site. If you do not have access to the site, email the IDDServicesacoffice@hhs.texas.gov.
Detailed Instructions
No. of Pages Submitted — Enter the number of pages submitted.
Person’s Last Name — Enter the person’s last name.
Person’s First Name — Enter the person’s first name.
Medicaid No. — Enter the person’s nine-digit Medicaid number.
Local Case No. (LCN) — Enter the person’s LCN.
LIDDA — Enter the name of the LIDDA.
Habilitation Coordinator’s Name— Enter the habilitation coordinator’s name.
Habilitation Coordinator Email — Enter the habilitation coordinator’s email address.
Required Forms to be Submitted — Select the forms or assessments you are submitting with this form.
Other Forms to be Submitted. Check all that apply — Select the forms or assessments you are submitting with this form.
Type of Submission — Select if the submission is a new request or a correction to a previous request.
Comments, Additional Information — Use this space to enter pertinent information you feel HHSC needs to know about the submission.