Information Letter No. 14-81 addresses the impact of the carve-in of acute medical care
services into managed care for certain persons enrolled in the Home and Community-based
Services (HCS) or Texas Home Living (TxHmL) programs as required by Senate Bill (SB)
7 (83rd Legislature, Regular Session, 2013) and the impact the carve-in will have on
expectations for program providers, including compliance with program rules as described
in Texas Administrative Code (TAC), Chapter 9, Subchapter D for HCS providers and
Subchapter N for TxHmL providers.
SB 7 requires the Health and Human Services Commission (HHSC) to provide acute care
Medicaid services for certain individuals with an intellectual disability through Medicaid managed
care. However, the bill made no changes to the federal regulations and state statutes and
regulations that currently govern HCS and TxHmL program compliance. Though the HCS or
TxHmL program provider is not responsible for the actual delivery of acute care services covered
under STAR+PLUS, the HCS or TxHmL program provider will still be responsible for showing
documentation of efforts to ensure delivery of an ordered service or procedure and protection of
the individual’s health and safety.
The HCS and TxHmL program provider is still required to provide nursing in accordance
with Appendix C of the HCS and TxHmL program waiver applications approved by
Centers for Medicare and Medicaid Services (CMS) and found at
http://www.dads.state.tx.us/providers/HCS/HCS_Waiver_Amendment2.pdf. Nursing in
accordance with Appendix C includes performing health care activities and monitoring the
individual’s health conditions. Appendix C further states that nursing includes assisting an
individual or legally authorized representative (LAR) to secure emergency medical services
for the individual and making referrals for appropriate medical services.
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