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Revision 06-1; Effective April 10, 2006
This section describes the interaction between the Texas Health and Human Services Commission (HHSC) and the Emergency Response Services (ERS) staff. This material is presented in a routine and chronological sequence of events, following the individual from initial application for services through service delivery and suspension/termination of services.
5110 Forms Needed
Revision 06-1; Effective April 10, 2006
- Form 2059, Summary of Client's Need for Service
- Form 2067, Case Information (The provider may use this form to meet Chapter 52, Contracting to Provide Emergency Response Services, requirements, as long as the provider ensures that the required information is documented on or attached to the form.)
- Form 2101, Authorization for Community Care Services
- Form 2110, Community Care Intake
5120 Referrals to Facility
Revision 06-1; Effective April 10, 2006
An applicant may be referred to an Emergency Response Services provider by the case manager. Section 5200, Provider Response to Case Manager Referral, describes the process you follow to initiate services for an individual referred through the case manager.
5130 Case Manager Service Planning Process
Revision 06-1; Effective April 10, 2006
Applicants/individuals apply for services by contacting a Community Care for Aged and Disabled (CCAD) case manager. The case manager conducts face-to-face interviews to determine if applicants meet eligibility criteria for the service. The case manager may authorize services for up to one year.
The case manager gives eligible applicants an explanation of the service. The applicants/individuals are advised that they are required to:
- participate in the service delivery requirements; and
- sign a release statement allowing the responder to enter the individual's home by force, if necessary, to assist the individual.
5140 Referral Process
Revision 06-1; Effective April 10, 2006
The region maintains a list of all Emergency Response Services providers. The list includes:
- vendor number,
- geographic areas served, and
- rate(s).
This information is provided to the individual to assist in making an informed choice. If the individual has no preference of providers, a referral will be made to the provider with the lowest rate. If more than one provider has the same lowest unit rate, referrals to individuals will be made on a rotating basis.
The case manager gives verbal approval when the individual needs an immediate response to the request for services. The service begin date is negotiated between the provider and case manager.
Providers will receive the referral packet within seven days from the verbally approved date.
5150 Interest Lists
Revision 06-1; Effective April 10, 2006
If, due to fiscal constraints, the Texas Health and Human Services Commission (HHSC) initiates an interest list, the case manager explains to the individual that the service is not currently available, and a referral will be made to the provider originally selected by the individual when intake is opened.