Determine eligibility for Community Care Services Eligibility (CCSE) services:
within 30 calendar days from date the signed application is received by the Texas Health and Human Services Commission (HHSC). Applications for Community Attendant Services (CAS) must be referred to Medicaid for the Elderly and People with Disabilities (MEPD) staff for a financial eligibility determination. Because the MEPD process can take up to 45 days for regular referrals and 90 days if a disability determination is required, this may delay Community Care Services Eligibility (CCSE) certification beyond the 30-day time frame.
2330
Conduct a home visit with all people who had initial assessments conducted in a place other than the person’s home:
within five business days from the date the applicant was determined eligible for a verbal referral.
2632
For applicants who do not require verbal referrals, authorize services by sending Form 2101 to the provider:
within five business days from the date the applicant is determined eligible.
2632
For services other than CAS, contact the provider if Form 2101 or another notification of status of referral is not received:
by the 21st calendar day from the date of referral.
2611.1
If the eligibility process is delayed past the 30-day time frame due to pending Medicaid for the Elderly and People with Disabilities (MEPD) eligibility:
the caseworker verifies MEPD status on or before the 25th day from the application date and performs weekly checks until the eligibility decision is received using the Texas Integrated Eligibility Redesign System (TIERS) records. The TIERS checks must be documented.
2663.1
If a functional reassessment mandates a change in the person's service plan:
the change must be processed within five business days or by the annual reassessment due date, whichever is earlier.
Service Monitoring and Evaluation
Section
First Step
Second Step
2711
Make a home visit for CAS people regardless of priority:
at least every 90 calendar days from the previous home visit.
2710.2
Make a home visit for priority status people other than CAS:
Make a home visit for non-priority status people other than CAS:
within six months of the last monitoring contact.
by the end of the sixth month following the previous monitoring contact.
Denying or Reducing Services
Section
First Step
Second Step
2810
Notify applicant in writing of ineligibility for service:
within two business days of the date of the decision.
2810, 2811
Notify the person in writing of reduction or termination of service:
Responding to Requests for Service Interruptions, Suspensions and Reported Changes
Section
First Step
Second Step
2810, 2721.6
Notify the person in writing when there is a change in type or amount of services authorized:
any changes in the person’s service plan. Examples include increases or decreases in units or hours of service, increases or decreases in copay, adding a new service or transfers from FC to PHC
2821
The provider must notify the caseworker of a suspension:
on the day of the suspension or by the first business day following the suspension.
2822.1
If a person enters a nursing facility, hospital or an institution, verify the action and determine probable length of stay. If length of stay is likely to be 30 days or less:
suspend services effective the date the person enters the nursing facility, hospital or institution and send Form 2067, Case Information, to providers.
2721.4
When learning of a change in the person's condition or status, revise the service plan or document why no changes are needed:
within 14 calendar days of learning of a change.
4445, 4673.4
When the person requires an immediate change in CAS, FC or PHC service plan due to situations listed in these sections, respond:
for FC, by the next business day and for PHC or CAS, within the same day of receipt of the request.
2736.1
When there is a reason to believe that a person has been abused, neglected or exploited, make a referral to Adult Protective Services or Child Protective Services, as appropriate:
within 24 hours if there is an immediate or imminent threat to the health and safety of the person.
