3200, Diverting from NF Admission

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Revision 22-1; Effective Nov. 28, 2022

HHSC may make available a targeted NF HCS diversion slot to a person with intellectual disability (ID) or developmental disability (DD) who is determined to be at imminent risk of a long term stay in a NF. After a positive PASRR Level 1 (PL1) screening for preadmission is completed and entered in the Long-Term Care (LTC) online portal, a LIDDA must conduct a PASRR Evaluation (PE) on the person to determine if the person:

  • has ID or DD; and
  • meets medical necessity.

3210 Criteria for Diverting from NF Admission

Revision 25-1; Effective Nov. 12, 2025

To be eligible for a targeted NF HCS diversion slot, a diversion coordinator must document the following:

  • the person is at imminent risk of a long-term stay in an NF;
  • the person has a PE, conducted within the past 21 calendar days, that indicates they have ID or DD, meet NF medical necessity and are appropriate for community placement;
  • the person has a diagnosis that will meet HCS diagnostic eligibility criteria, meaning they have an intermediate care facility (ICF) Level of Care (LOC) I or VIII*; and
  • other adequate and appropriate community resources, excluding SSLCs, are unavailable to meet the person’s needs after attempts to obtain community-based services and supports, such as:
    • for a person 21 years or older:
      • Medicaid State Plan services;
      • community-based intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IIDs) with six beds or fewer; and
      • general revenue-funded services; or
    • for a person 20 years or younger:
      • Medicaid State Plan services;
      • supports through the local school district;
      • general revenue-funded services; and
      • community-based ICF/IIDs with six beds or fewer unless out-of-home placement is not desired.

*If a LIDDA determines the person meets the criteria for both ICF LOC I and VIII, then the LIDDA documents ICF LOC I. If the person only meets the criteria for ICF LOC VIII, then the LIDDA documents ICF LOC VIII.

3220 Requesting a Targeted NF HCS Diversion Slot

Revision 25-1; Effective Nov. 12, 2025

If a LIDDA determines a person meets the criteria for a targeted NF HCS diversion slot, the diversion coordinator completes and submits Form 1047, Request for HCS Targeted NF Diversion Slot, per the form’s instructions to request a slot for the person.

Upon receipt, HHSC staff reviews the completed Form 1047. HHSC staff may request more information or documentation. Within three business days after receipt of Form 1047 and any other needed documents, HHSC determines if the person meets the criteria for a targeted NF HCS diversion slot.

  • If HHSC determines the person does not meet the criteria, staff will notify the LIDDA and the person or legally authorized representative (LAR) in writing of the denial of an offer of a targeted NF HCS diversion slot within one business day. HHSC will provide the person or LAR with an opportunity for a fair hearing.

If HHSC determines the person meets the criteria and a targeted NF HCS diversion slot is immediately available, staff will send a letter authorizing the LIDDA to offer the person the opportunity to enroll in HCS.

3230 Enhanced Community Coordination Responsibilities for Enrolling in HCS as a Diversion from NF Admission

Revision 25-1; Effective Nov. 12, 2025

Enhanced Community Coordination (ECC) helps people with intellectual or developmental disabilities divert or transition from NFs to homes in the community.

All people diverting or transitioning from an NF and enrolling in a 1915(c) waiver are eligible to receive ECC. ECC is not to be used for diversions or transitions to an ICF/IID.

Note: Refer to 9000 of the Local Intellectual and Developmental Disability Authority Handbook for ECC responsibilities for diverting or transitioning from an SSLC or ICF/IID.

A person may enroll in the HCS program as an alternative to NF admission, per 26 Texas Administrative Code (TAC) Chapter 331, LIDDA Service Coordination, and 26 TAC Section 263.901, LIDDA Requirements for Providing Service Coordination in the HCS Program, and the LIDDA Handbook. A LIDDA must make sure an ECC coordinator:

  • is assigned within three business days after an HCS waiver slot is received;
  • completes the initial visit with the person and their LAR, if applicable, within seven business days after being assigned;
  • develops and revises as necessary a diversion plan, using Form 1050, Nursing Facility or Crisis Diversion Plan, with the person and LAR;
  • develops Form 8665, Person-Directed Plan, per the HCS program rules, using all available assessments, and includes the person’s strengths and preferences;
  • initiates development of the initial individual plan of care (IPC) as outlined in 13240, Individual Plan of Care of the LIDDA handbook;
  • conducts, in person, a pre-move site review using Form 1042, Pre-Move Site Review;
  • determines whether all essential supports identified on Form 1050, Nursing Facility or Crisis Diversion Plan, are in place and any areas of concern have been addressed before the person enrolls in the HCS Program; and
  • completes the following activities before the person enrolls in HCS if, during the pre-move site review, any one of the essential supports is not in place or if issues are raised about the suitability of the site:
    • convenes the Service Planning Team (SPT) to resolve the issues; and
    • conducts another pre-move site review following resolution.

When a person expresses the desire to divert from an NF admission to a home in another LIDDA’s service area, the sending LIDDA’s ECC coordinator should invite the receiving LIDDA’s ECC coordinator to all diversion planning meetings. The receiving LIDDA’s ECC coordinator may attend diversion planning meetings in person, by audio-visual technology or by phone.

The sending and receiving LIDDAs must work together to make sure essential supports are in place before the person’s move. This includes determining who will be responsible for conducting the pre-move site review, considering time and distance to the site, and sharing a copy of the pre-move visit with the other LIDDA. The sending LIDDA should document any discussions with the receiving LIDDA.

The transfer of LIDDAs must not occur until all essential supports have been verified through a pre-move visit.

At its discretion, HHSC may determine the designated LIDDA for any person or assign a LIDDA the duties of the designated LIDDA for any person, as outlined in LIDDA Handbook 5000, Guidelines for Determining and Changing the Designated LIDDA.

A non-designated LIDDA is not prohibited from serving a person who is currently being served by their designated LIDDA. 

3240 ECC-Designated Funds

Revision 25-1; Effective Nov. 12, 2025

ECC-designated funds are available to LIDDAs through the performance contract for a person enrolling in HCS as a diversion or transition from an NF. The purpose of the funds is to enhance a person’s natural supports and promote successful community living. Funds are intended to pay for:

  • one-time emergency assistance, such as:
    • security deposit or utility assistance;
    • nutritional supplements;
    • clothing; and
    • medication;
  • items to address a person’s special needs, including minor home modifications not funded by other sources;
  • transportation to and from trial visits with community providers; and
  • educational tuition assistance, such as for vocational programs through community colleges so a person can develop job skills.

All other funds, including transition assistance services (TAS) and supplemental transition services (STS), must be exhausted, and all purchases must be approved before ECC designated funds may be used.

LIDDA staff may access ECC funds by completing Form 8658 and submitting it to IDDMFPsupport@hhs.texas.gov.

3250 Post Enrollment in HCS as a Diversion from NF Admission

Revision 25-1; Effective Nov. 12, 2025

For one year after a person has enrolled in the HCS program as a diversion from NF admission, an ECC coordinator must:

  • conduct and document on Form 1043, Post-Move Monitoring, at least three onsite post-move monitoring visits of community service delivery sites during the first 90 calendar days after the person’s move at the following times*:
    • within the first seven calendar days after enrollment in the HCS program;
    • between eight and 45 calendar days; and
    • between 46 and 90 calendar days; and
  • during the post-move monitoring visits:
    • assess whether essential supports identified in Form 1050, Nursing Facility or Crisis Diversion Plan, are in place;
    • ensure concerns of the person, program provider, staff or family member are being addressed;
    • identify gaps in care; and
    • address any gaps to reduce the risk of crisis, re-admission to an NF or other negative outcome.
  • conduct monthly in-person visits with the person, or more frequently if determined by the HCS SPT based on risk factors, and monitor the delivery of all services and supports;
  • conduct HCS SPT meetings at least every 90 days**, or more frequently if there is a change in the person’s needs or if requested by the person or LAR;
  • revise the HCS person-directed plan (PDP) as necessary, and coordinate the person’s services and supports;
  • ask about any recent hospitalizations, emergency department contacts, increased physician visits or other crises, including medical crises, and if the person experiences such, convene the HCS SPT to identify all necessary revisions to the HCS PDP to address other need for services;
  • make sure the person receives timely assessments of behavioral, medical, nursing, specialized therapies and nutritional management needs, as necessary, and as indicated on the HCS PDP;
  • record health care status sufficient to readily identify when changes in the person's status occurs;
  • conduct service planning, ensure the program provider’s implementation of services, and monitor all services identified on the HCS PDP, including:
    • reviewing the HCS program provider’s implementation plans and provider records;
    • visiting service delivery sites as needed to determine the person’s needs are being met; and
    • monitoring critical incidents involving the person and convening the HCS SPT to develop a plan for needed prevention or intervention services for the person; and
  • monitor the person while on suspension from the HCS program at least monthly, maintain communication with the program provider, and provide reports to HHSC upon request.

*More frequent onsite visits may be required to determine if supports continue to be in place and any areas of concern are being addressed during the first 90 calendar days after enrolling in HCS.

**SPT meetings may be held up to 10 days before the next scheduled SPT meeting. The SPT meeting schedule does not reset.

The ECC coordinator must conduct post-move monitoring at all sites where essential supports are provided.

If, by the 335th day of ECC, the SPT believes the person will require more than 365 days of enhanced monitoring, the ECC coordinator must contact IDDMFPSupport@hhs.texas.gov for guidance.