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Home and Community-based Services and Texas Home Living Programs
Quarterly Webinar – May 10, 2019
Agenda
• Intellectual Developmental Disabilities Operations Portal Update
• HCS/TxHmL Migration to TMHP
• Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities
• Electronic Visit Verification
• Waiver Survey and Certification
• Monitoring and Maintaining Medicaid Eligibility
Intellectual Developmental Disabilities Operations Portal Update
Angie Hutchison
IDD Program Eligibility and Support
IDD Operations Portal
Update
• Registration began on April 1, 2019 with implementation progressing in four stages
• For more information visit our website at:
https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/idd-ops-portal
• For technical issues, contact the IDD Operations Portal Team at [email protected]
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HCS & TxHmL Forms and Claims Migration ProjectImplementation Date
March 2, 2020
Purpose of project
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Modernization
A phased approach to replace legacy technology systems with an ecosystem that better reflects the Texas Medicaid business model today and is more adaptable for future needs.
Result will be more efficient, system-driven processes, and data capabilities that better support business objectives.
Standardization
HCS and TxHmL processing will be done in the same systems used by other HHSC Long Term Services and Support (LTSS) programs.
Waiver Interest ListsCommunity Services Interest
Lists (CSILs)
Service Authorization Functionality
Integrated LTC Online Portal & HHSC Service Authorization
System (SAS)
Claims Processing Texas Medicaid & Healthcare Partnership (TMHP) Claims Management System (CMS)
What’s moving out of ID-CARE
ID-C
ARE
Functions moving out of ID-CARE into standardized HHSC systems
Major advantages
More dynamic claims capability
Daily or weekly claims processing
Claims entry with date ranges
Eliminates manual service authorization entry into the
EVV Vendor system
Opportunity to become an EDI submitter
TMHP uses adopted standards for 3rd party submitters
More timely and ability to batch
Reduces administrative burden, less data entry
New processes in March 2020
Enter into the TMHP Long Term Care Portal
• 8578 - ID/RC Assessments• 3608 & 8582 - Individual Plans
of CARE (IPC) • 3616 - Terminations• 3617 - Transfers • 3615 – Requests to Continue
Suspension• Maintain Suspension process• Local Intellectual and
Developmental Disability Authority (LIDDA) Reassignments
• Individual Demographic Information Update
• Provider Location Setup and Maintenance
• Service Coordinator Updates
Enter into TMHP CMS System
Claims using either TexMedConnect or Electronic Data Interchange (EDI)
Maintain in Community Services Interest List System (CSIL)
Interest Lists for HCS and TxHmL
HHSC Manage Slot Tracking System
HHSC management of Slot Tracking for HCS & TxHmL using SAS Admin Application
1185 Permanency Plan Status Report
249 PPR Approval Status (Inquiry)
309 Permanency Plan Review
686 Critical Incident Update
286 Critical Incidents Data Inquiry
C97 WS/C Authority Review Notations
410 Add Case to ID / Demographics
325 Register Client: CARE-ID
360 Death/Separation of Client: Add/Change/Delete
What’s staying in ID-CARE
ID-C
ARE
Some reports will still be available through the existing Filezilla folder(s): More information to follow
HCS / TxHmL Business Process Flow
HHSC Service Authorization
System (SAS)
TMHP ClaimsManagementSystem (CMS)
EDI Claims
Submission
ID-CARE
CSIL
Slot Tracking
Register PeopleInterested in LTSS
Out-Reach forPeople released from
Interest List
Large BatchClaims
ServAuths
Data for .Legacy Reports
Track SlotsFor HCS & TxHmL
CARERegistration
TMHP.COM
TMHP LTCOnline Portal
TexMedConnect
MESAV
Assessments & Service Plans
Entry
HCS, TxHmLClaims Entry
ServAuths
HCS, TxHmLClaims Entry
Serv AuthInq.
Serv AuthInq.
Provider / Local Authority
HHSC ReleaseManagement
Staff
CAREInfo
Ways to Prepare for the Transition
Stay informed
Sign up for Gov Delivery
Read information published in the LTC Provider Bulletins
Log into TMHP website for updates
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https://service.govdelivery.com/accounts/TXHHSC/subscriber/new
http://www.tmhp.com/Pages/LTC/ltc_home.aspx
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HHSC will provide updates as they become available
Stay current
Keep claims submissions current in ID-CARE
Submit renewals, returns, etc. in a timely manner
Initiate technology updates
TMHP does NOT support dial-up. Obtain an internet service provider.
Required
Become an EDI submitter for batch claims submission.
Optional but recommended
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Get specifications on submitting an LTC Professional Claim - Long Term Care Companion Guide v5010 837P
Go to the TMHP EDI website
Review the TMHP Connectivity Guide
http://www.tmhp.com/Pages/EDI/EDI_companion_guides.aspx
Contact the TMHP EDI help desk
1-800-626-4117, Select option 3
Setup a submitter ID
Test the file submission
Take the claims training
TMHP Computer-based training on claims submission at: http://learn.tmhp.com/
Services effective
Mar. 1, 2020 or later
• Claims for services entered through the TMHP LTC Online Portal must be billed through TMHP
• May bill through TMHP TexMedConnect or submit batches of claims through the TMHP Electronic Data Interchange (EDI)
March 1, 2020
Services established in CARE prior Mar. 1, 2020
• Must be submitted through ID-CARE
Register for a TMHP logon ID
• Separate IDs are required for forms and claims entry
Local Authorities will need a logon to submit forms if they do not already have one for ICF/IID forms
• Logon IDs for TexMedConnect and the TMHP LTC
Online Portal are not the same system IDs
• IDs setup to take the TexMedConnect CBT cannot be
used for claims submission through TexMedConnect
Mark your calendar to register closer to implementation.
Passwords expire if not used within 30-days, accounts are disabled after 90-days
Where to set up your logon
1.Go to TMHP.com
2.Select the Provider tab at the top
3.Click ‘I would like to’ on the upper right-hand side
For TMHP TexMedConnect and LTC Online Portal
For help call
1-888-863-3638
Terminology nuances
CARE ID
Only applicable to the ID-CARE system
Medicaid ID (Client Number)
How clients are identified in TMHP Portal and TexMedConnect
Provider Identification
Providers are identified by their 9-digit HHSC Provider Number and/or 10-digit National Provider Identifier (NPI)
Vendor ID and HHSC Provider Number
Used for TMHP Portal security
• This is your CARE Component Code (preceded by a zero)• TMHP refers to this as the Vendor ID since not all programs have a
CARE Component Code
Questions?
Visit TMHP.com to review current information and new information. Examples include:
✓ Provider user guides
✓ Webinars
✓ FAQ documents
Contact us at:
Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities
Nova Evans
Senior Behavioral Health Policy Analyst
Mental Health Wellness for Individuals with Intellectual and Developmental Disabilities
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MHW-IDD Training Modules-DSW Series
• Co-occurring Disorders: IDD and Mental Illness
• Trauma-informed Care for Individuals with IDD
• Functional Behavior Assessment and Behavior Support
• Overview of Genetic Syndromes Associated with IDD
• Overview of Medical Diagnoses Associated with IDD
• Putting It All Together: Supports and Strategies for Direct Service Workers
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MHW-IDD Training Modules-HPC Series (cont.)
• Integrated Healthcare for Individuals with IDD –for health care professionals (HCPs)
• Communicating with Individuals with IDD – for HCPs
• Trauma-informed Care for Clinical Providers – for HCPs
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Changes to Website
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New log-in process
• Username is your email address
• Need to remember username and password
Option for purchasing CEs
• Secure e-payment system for CE purchase
• Does not store credit card info
Questions?
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Thank You
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HHSC Electronic Visit Verification
What is Electronic Visit Verification?
• Electronic Visit Verification (EVV) is a computer-based system that electronically verifies that service visits occur; and documents the:
• Member receiving services
• Attendant providing services
• Location of service delivery
• Date of service delivery
• Time the attendant/staff begins and ends service delivery
• EVV Visits are required for EVV claim payments.
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21st Century Cures Act
The 21stCentury Cures Act Section 12006 (Cures Act), is a federal law requiring all states to use EVV for Medicaid personal care services (PCS) and home health services; including services delivered through the Consumer Directed Services (CDS) option and the Service Responsibility Option (SRO).
States must implement EVV or risk a loss of federal Medicaid matching dollars.
PCS must start by Jan. 1, 2020.
Home health services must start by Jan. 1, 2023.
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How Does EVV Work?
• When an attendant provides services to a member in the home or community, the attendant will use one of three approved EVV time recording methods to clock in when service delivery begins and clock out when service delivery ends:
• Mobile Application
• Alternative Device
• Member’s Home Phone Landline
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Clocking In/Out of the EVV System
• When the attendant uses of one the three methods, an EVV visit transaction is created with the clock in and clock out time.
• Contracted providers will be trained on the use of the EVV system by the EVV vendor of their choice.
• The contracted providers are then responsible for training their staff on the use of EVV.
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How to Prepare for EVV
• The EVV Tool Kit is a collection of resources that will help prepare contracted providers, Financial Management Services Agencies (FMSAs), and Consumer Directed Services (CDS) employers in the use of EVV.
• The tool kit is located on the HHSC EVV website and consist of:
• Web Alerts
• Webinars
• Frequently Asked Questions (FAQ)s, and
• Tips
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Tip #1
EVV Tool Kit
• Sign up for GovDelivery email notices and receive EVV alerts.
• Review materials in the EVV Tool Kit.
• Visit the following websites for more information about EVV:
• HHSC EVV
• Your MCO
• TMHP
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Tip #2
Know Your Identification Data
• Contracted providers, know your identification
data, such as:
• HHSC provider number
• MCO and associated National Provider Identifier
(NPI) Number
• MCO service delivery area
• Healthcare Common Procedure Coding System
(HCPCS) code and associated modifier
• Service group and service code
• Tax Identifier Number (TIN) 35
What’s next?
• May 22, 2019: Live Webinar Q&A Session
• EVV Claims and Standard Reports
• Register for the webinar
• June 1, 2019 Web Alert:
• EVV Policy and Process Requirements
• June 15, 2019 Web Alert:
• EVV Oversight
• FAQs
Waiver Survey and Certification
May 2019
Agenda
• Survey Process Changes
• Top 10 Citations
HCS and TxHmL Webinar May 2019 39
Survey Process Changes
Change?!
HCS and TxHmL Webinar May 2019 41
What changes are going to happen?
• Statement of Concerns
• IR timeline will happen on receipt of the final report
• Plans of Correction (TBD)
HCS and TxHmL Webinar May 2019 42
Desired Outcomes
• Surveys will be conducted in a much shorter timeframe than they are now
• Reports will be more concise and clearer for the provider
HCS and TxHmL Webinar May 2019 43
Statement of Concerns
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Statement of Concerns
HCS and TxHmL Webinar May 2019 45
Statement of Concerns
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Statement of Concerns
What happens once the provider receives the statement?
• The provider should start to work on the plan of correction for any items that remain outstanding.
What does the plan of correction look like?
• It will be very similar to the CAP that you are used to doing now.
• It will require a plan on how the provider intends to correct the citation, the date by which it will be corrected, and who will be responsible for ensuring it is completed.
• The POC is due 10 business days from the date of exit.
HCS and TxHmL Webinar May 201947
Statement of Concerns
Will the provider be recertified for the next year?
• The provider will not be recertified when serious items are out of compliance.
• The provider may be recertified when non-serious items are found and a corrective action plan is in place.
Can a provider still correct issues of noncompliance during the visit?
• Yes, but providers will likely have less time to correct items that are out of compliance before the exit conference because surveys will occur in a shorter time period.
HCS and TxHmL Webinar May 201948
Statement of Concerns
How will surveyors review follow up items?
• Follow up items must be ready to be reviewed at the start of the survey (Tuesday at 9am).
• If evidence of correction is not available at the start of the survey, then follow up items will be marked out of compliance and the surveyors will move on to conducting the survey.
HCS and TxHmL Webinar May 201949
Statement of Concerns
When do I get the final report?
• The final report is due 10 business days from the date of exit.
• The Informal Review timer will start on the third business day after the date of the final report.
• We are estimating 3 business days for receipt of the final report from the time it is mailed.
• There will be 7 calendar days time to file the IR once the final report is received.
HCS and TxHmL Webinar May 201950
Statement of Concerns
What should I do if I do not agree with the surveyors findings on the SoC?
• Begin working on correcting the item
• Once you receive the final report, file your informal review
• Providers should work on the correction while the informal review (and eventually IDR process) is ongoing.
HCS and TxHmL Webinar May 201951
Statement of Concerns
What is the benefit of this new system?
• Surveys should be conducted much quicker
• The SOC will state, specifically, what is wrong (less guessing)
• No more reading through 2-200 pages of TAC/history, at the end of a survey, to figure out the issue the provider needs to correct
• More time to work on informal reviews (almost 21 days compared to 7 days)
• Preparation for administrative penalties process
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Statement of Concerns
When will the statement of concerns be implemented?
• May 1st: providers will start seeing the statement of concerns on surveys.
• By September: WSC will have surveyed the major providers and many of the small providers and at this time, we will likely drop the preliminary report and switch over to the statement of concerns.
HCS and TxHmL Webinar May 2019 53
Top 10 Citations for FY 2019
Top 10 Citations for FY 2017: HCS
HCS and TxHmL Webinar May 2019 16
Top 10 Citations (HCS)
Principle Number Brief Summary
§9.178(y) A program provider must enter critical incident data
§9.177(d)(1)(A) Staff members and service providers are qualified to deliver services as required
§9.174(a)(31)(B) Monitoring the individual's use of medications;
§9.174(a)(3)Provide or obtain as needed and without delay all HCS Program services and CFC services;
§9.174(a)(31)(J)(ii) Documenting information from performance of a nursing assessment;
§9.178(g) The program provider must make available all records, reports, and other information
§9.178(c)(2)Ensure that the service coordinator is provided with a copy of the results of the on-site inspection
§9.174(a)(31)(C) Monitoring health risks, data, and info
§9.177(n) Background checks
§9.173(b)(21) Inform of progress/lack of progress in IP and Transportation Plan.
Top 10 Citations for FY 2017:TxHmL
HCS and TxHmL Webinar May 2019 56
Top 10 Most Cited (TxHmL)
Principle Number Brief Summary
§9.580(r) A program provider must enter critical incident data
§9.579(d)(1)(A)Conduct initial and periodic training that ensures: staff members and service providers are trained and qualified to
deliver services
§9.579(d)(1)(B)Conduct initial and periodic training that ensures: staff members, service providers, and volunteers are
knowledgeable about ANE
§9.579(r) The program provider must comply with §49.304 of this title (relating to Background Checks).
§9.578(d)(1) TxHmL Program services in accordance with an individual's PDP, IPC, implementation plan, transportation plan, etc.
§9.580(e)(1) Ensure that the individual and LAR are informed of how to report ANE to DFPS and are provided the phone no.
§9.580(k)
At least quarterly, the program provider must review incidents of abuse, neglect, or exploitation, complaints, temporary suspensions, terminations, transfers, and critical incidents to assess trends and identify program operation modifications that will prevent the recurrence of such incidents and improve service delivery.
§9.578(q)(1)A program provider may determine that an individual does not require a nursing assessment if: Nursing services are not on the individual's IPC and the program provider has determined that no nursing task will be performed by the program provider's unlicensed service provider as documented on DADS form "Nursing Task Screening Tool".
§9.580(a)(20)(B) Inform the individual or LAR, orally and in writing: if the requirements described in this subsection are revised;
§9.580(a)(21)(C)Obtain an acknowledgement stating that the information described in paragraph (20) of this subsection was provided to the individual or LAR and that is signed by a third-party witness.
Contact Information
• Regulatory-Related Questions:
• Billing and Payment Questions:
• Contract Questions:
• Consumer Rights and Services:
HCS and TxHmL Webinar May 2019 18
Monitoring and Maintaining Medicaid Eligibility
Home and Community-based Services and Texas Home Living
Agenda
• Financial Eligibility – Medicaid
• Medicaid or SSI
• Medicaid Transfers
• Monitoring Medicaid
• Loss of Medicaid - Most Common Reasons
• Best Practices
• Resources
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Financial Eligibility
Medicaid
• An applicant must be eligible for a Medicaid program that is accepted in HCS or TxHmL on or before the enrollment date.
• Medicaid eligibility must be maintained for continued HCS or TxHmL enrollment.
• For full eligibility rules, visit 40 Texas Administrative Code (TAC), Chapter 9
• HCS: §9.115
• TxHmL: §9.556
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Medicaid or SSI
Medicaid
• The current federal benefit rate (FBR) is $771 for individuals and $1,157 for couples.
• A person whose monthly income is less than the FBR, should apply for Supplemental Security Income (SSI) with the Social Security Administration (SSA).
• If approved, the person receives SSI Medicaid.
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Medicaid or SSI
Medicaid
• A person whose monthly income is more than the FBR or who have been denied SSI, should apply for Medicaid with HHSC Medicaid for the Elderly and People with Disabilities (MEPD).
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Medicaid Transfers
Medicaid
• A Medicaid program transfer is requested for people leaving a State Supported Living Center (SSLC) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) to enroll in HCS or TxHmL.
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Medicaid Transfers
Medicaid
• After a level of care and individual plan of care are approved but, not before the enrollment begin date, HHSC Eligibility Verification and Program Support requests a program transfer from MEPD or Data Integrity.
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Monitoring Medicaid
CARE Screen C63, Medicaid Information
• The CARE screen C63 displays a Medicaid program code for each person and an annual renewal date for non-SSI Medicaid recipients.
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Monitoring Medicaid
CARE Screen C63, Medicaid Information
• An end date is only displayed when Medicaid has ended or will end.
• Program code “13” is SSI Medicaid. Medicaid annual renewals do not apply to SSI Medicaid.
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Medicaid for HCS or TxHmL
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Coverage
Code
Program
Type CodeHCS TxHmL
Coverage
Code
Program
Type CodeHCS TxHmL
R or P 01 √ √ R or P 22 √ √
R or P 02 √ √ R or P 29 √ √
R or P 03 √ √ R or P 37 √ √
R or P 07 √ √ R or P 40 √ √
R or P 08 √ √ R or P 43 √ √
R or P 09 √ √ R or P 44 √ √
R or P 10 √ √ R or P 45 √ √
R or P 11 √ √ R or P 47 √ √
R or P 12 √ √ R or P 48 √ √
R or P 13 √ √ R or P 51 √ ------
R or P 14 √ ------ R or P 55 √ √
R or P 15 √ √ R or P 61 √ √
R or P 18 √ √ R or P 82 √ √
R or P 19 √ √ R or P 87 √ √
R or P 20 √ √ R or P 88 √ √
R or P 21 √ √ ------ ------ ------ ------
Monitoring Medicaid
Provider Report HC063870.M Lost/Losing
LIDDA Report HC063660.M Lost/Losing ME
• A monthly report of people who have lost or will lose Medicaid by the end of the month.
• Available through JHSXPTR/CARE.
• Sent to providers and LIDDAs through the Globalscape FTP.
• Each provider and LIDDA receive a report of people enrolled with them only.
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Loss of Medicaid
Most Common Reasons
• Missed Medicaid annual renewal due date
• MEPD mails renewal documents to the AR at least 90 days before the due date.
• If the renewal documents are not received at least 30 days before the due date, MEPD mails the documents again.
• If the renewal documents are not received by the due date, Medicaid is denied.
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Loss of Medicaid
Most Common Reasons
• Missed due date for requested documentation
• If MEPD cannot reevaluate financial eligibility, Medicaid is denied.
• Income or resource increase
• If it results in Medicaid ineligibility, financial eligibility criteria is no longer met.
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Loss of Medicaid
Most Common Reasons
• Address change not reported
• May result in annual renewal documents being mailed to the wrong address.
• May result in suspension of SSI Medicaid.
• Medicaid application not received
• When Medicaid is lost; including SSI Medicaid, a new application is needed.
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Loss of Medicaid
Most Common Reasons
• Application is missing Form H1746A, MEPD Referral Cover Sheet
• This form is required with all applications for people in HCS or TxHmL.
• The form must be submitted by a provider or LIDDA.
• Prior coverage is not automatically granted. It must be requested in the comments section of the form.
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Best Practices
Check Medicaid information in the CARE C63.
• A LIDDA can check while enrollment or transfer is pending approval.
• After approval, the provider can check.
Check Medicaid information at least monthly.
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Best Practices
Track annual renewal dates.
• HHSC is developing reports for due dates.
Assist the AR with documents by the due date.
• A LIDDA can also assist if asked by the individual/AR.
Print and review the lost/losing ME report monthly.
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Best Practices
When attempting to reinstate Medicaid, work quickly.
• Prior coverage is for 3 months only.
Keep the LIDDA informed of all changes; especially when eligibility is affected.
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Important Medicaid Forms
Form, H1003, Appointment of Authorized Representative
• An individual can appoint an authorized representative (AR) who has knowledge of their finances and is able to submit required financial documents to MEPD.
• The provider should only be the AR if there is no other option and only one AR is allowed.
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Important Medicaid Forms
Form H1826, Case Information Release
• An individual can authorize release of Medicaid information to their provider or LIDDA.
Form H1019, Report of Change
• The provider or LIDDA can assist a non-SSI recipient to report changes by submitting to this form to HHSC.
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Important Medicaid Forms
Form H1746A, MEPD Referral Cover Sheet
• A provider or LIDDA can also report a change on behalf of the individual.
Note: Only the representative payee can report changes for SSI recipients.
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Resources
• For Medicaid Assistance, visit yourtexasbenefits.com or call 2-1-1
• For MEPD policy information or Medicaid Case Escalation, contact MEPD at [email protected]
• For MEPD Handbook and Forms, visit https://hhs.texas.gov/laws-regulations/handbooks/mepd/medicaid-elderly-people-disabilities-handbook
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Resources
• For SSI information, visit www.ssa.gov or call (800) 772-1213
• For assistance with the CARE/JHSPTR application, call the HHSC Help Desk at 512-438-4720
• For questions about HCS or TxHmL enrollments, transfers, suspensions, or terminations, contact IDD PES at [email protected]
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Resources
• For HCS/TxHmL policy questions, email: [email protected] or [email protected]
• For HCS/TxHmL Handbook and Forms, visit https://hhs.texas.gov/laws-regulations/handbooks/home-community-based-services-handbook
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Questions
Thank You
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