Texas Department of Aging and Disability
Services
Community Living Assistance and Support
Services Provider Manual
Revision: 14-1
Effective:
Section 3000
Direct Service Agency (DSA)
3100 DSA Responsibilities
Revision 11-1;
All individuals who receive Community Living Assistance and Support Services (CLASS) must
choose a DSA with a valid provider agreement that operates in the catchment area in which the
individual lives. Individuals who receive services in CLASS may request to transfer to another
DSA at any time.
A DSA provides CLASS services to the individual as outlined in their Individual Plan of Care
(IPC). An individual may elect to have some or all of their services delivered by the DSA. Select
services may be chosen for self-direction by the individual or legally authorized representative
(LAR) using the Consumer Directed Services (CDS) option. For a complete list of CLASS
services available using the CDS option, refer to Section 4000, Consumer Directed Services
(CDS).
As outlined in this section, the individual's selected DSA is required to perform the following
tasks on behalf of an individual in CLASS on an ongoing basis:
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provide required documentation to DADS as is necessary to assess and renew the level of
care for the individual;
participate in developing a habilitation plan to outline the individual's habilitation needs
and complete documentation of that plan;
participate in developing an IPC that addresses all of the individual's needs that will be
met through the provision of CLASS services;
provide all CLASS provider-managed services according to the Individual Program Plan
(IPP);
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Monitor the DSA's service provision processes to ensure services are delivered by
qualified service providers in accordance with the IPP; and
Coordinate with the Case Management Agency (CMA) and other service providers as
necessary to ensure IPC revisions are initiated as necessary in response to changes in the
individual's needs.
CLASS program services as a whole enhance an individual's integration in the community and
prevent admission to an institution while maintaining and improving independent functioning.
3110 Base of Operation
Revision 11-3; Effective November 18, 2011
CLASS program providers must have a base of operation that includes a physical location and
normal operating hours in each geographic catchment area for which they have a contract to
provide CLASS program services.
1. A base of operation is a place in which business, clerical or professional activities are
conducted. Each base of operation must:
o maintain individual records for the CLASS program contract in the catchment
area;
o maintain personnel records for personnel who provide CLASS program services
to individuals served in the catchment area;
o be staffed by qualified employees who have completed CLASS program training
and can readily become familiar with the individuals being served in the
catchment area; and
o maintain adequate staff to provide services and to supervise the provision of
services within the catchment area.
2. Providers must identify the base of operation's normal operating hours. If the base of
operations is closed during its normal operating hours or between the hours of 8:00 a.m.
and 5:00 p.m. Monday through Friday, the provider must:
o post a notice in a visible location outside the base of operations to provide
information regarding how to contact the person in charge; and
o leave a message on an answering machine or similar electronic mechanism to
provide information regarding how to contact the person in charge.
3120 Service Planning Team (SPT) Meetings
Revision 11-3; Effective November 18, 2011
SPT activities may occur via conference call in lieu of a face-to-face meeting at the discretion of
the team. Annual reassessments must take place in person. Some individuals and families may
prefer to have everyone participate in person and when this is the case, SPT members are
expected to be sensitive to this and to make every effort to accommodate such requests.
Participation in an SPT via conference call is not reimbursable to the DSA using habilitation.
Reference: Information Letter 11-79, New Service Limits and Elimination of Requisition and
Specification Fees in the CLASS Program, attachment: "Guide For Service Limit
Implementation," Page 2; published Sept. 8, 2011.
An individual's service plan must be signed in person by the SPT group at enrollment and
renewal meetings. However, revisions of the current service plan may be signed by facsimile.
3130 DSA Staff Training Requirement
Revision 12-1; Effective January 13, 2012
3131 Initial Training for Direct Care Staff
Revision 13-2; Effective September 6, 2013
Direct Service Agency (DSA) program director(s) and any DSA staff person who has direct
contact with an individual receiving services through the Community Living Assistance and
Support Services (CLASS) program must complete one of the following within 60 calendar days
of the employee beginning to work with the CLASS program:
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In-person CLASS Provider Training provided by DADS; or
Training developed by the DSA that includes, at a minimum:
o CLASS program overview;
o Person-centered planning;
o Philosophy and values of community integration;
o Overview of related conditions and CLASS program eligibility criteria;
o Service Planning Team (SPT) process;
o Utilization Review process;
o Consumer Directed Services; and
o Individuals' rights and responsibilities including:
 Fair Hearing process;
 DSA's complaints process;
 Mandatory participation requirements; and
 Abuse, neglect and exploitation characteristics and reporting information.
The DSA could choose to conduct training at its location to meet the above requirements within
60 days of hiring the service provider. DSA staff who develop the curriculum used for initial
training must have attended and successfully completed the CLASS Provider Training. The DSA
must have a record to verify that the trainer has attended the CLASS Provider Training. The
DSA may choose to send new employees to CLASS Provider Training at the next opportunity
offered by DADS to further reinforce training provided by the DSA.
Documentation of completion of required training must include, at a minimum:
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CLASS Provider Training completion certificate with the name of the employee, signed
by DADS; or
Written documentation of completion of the DSA's training that includes:
o Training topics covered;
o Method of training (i.e., reading, video, discussion, etc.);
o Name(s) and qualifications of instructor(s);
o Name of the trainee;
o Date the training was completed;
o Signature and date of the instructor(s); and
o Signature and date of the trainee verifying completion.
If a DSA develops curriculum to meet CLASS training requirements, the curriculum and training
materials used must be maintained by the DSA and available to DADS employees during a
contract monitoring review. DSA staff who develop the curriculum used for initial training must
have attended and successfully completed the CLASS Provider Training. Verification of the
DSA training instructor's completion of CLASS Provider Training must be maintained and
available to DADS employees during a contract monitoring review.
3131.1 Initial Training for Habilitation and Respite Service Providers
Revision 13-2;
The Direct Service Agency (DSA) must ensure habilitation (Service Codes 10, 10A and 10B)
and respite (Service Codes 11 and 11A) service providers:
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Receive in-person training in the habilitation activities necessary to meet the needs and
characteristics of the individual to whom the service provider is assigned.
o Training must occur in the individual's home with full participation from the
individual, if possible; and
o Form 3599, Habilitation Service Provider Orientation/Supervisory Visits, is used
to document this orientation as stated in the directions for the form.
Complete two hours of habilitation training, developed by the DSA, before providing
services to an individual in the CLASS program that includes at a minimum:
o CLASS program overview;
o Overview of related conditions to include:
 the definition of a related condition; and
 examples of a related condition.
The information specific to related conditions noted above is located on the DADS
website at: http://www.dads.state.tx.us/providers/guidelines/ICD-9CM_Diagnostic_Codes.pdf.
Receive an explanation of commonly performed tasks regarding habilitation.
Understand an individual's rights and responsibilities including:
o DSA's complaints process;
o mandatory participation requirements; and
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abuse, neglect and exploitation characteristics and reporting information.
Successfully complete hands-on training in cardiopulmonary resuscitation (CPR) and
choking prevention before delivering services and annually thereafter that includes an inperson evaluation by a qualified instructor verifying the service provider's ability to
perform these actions.
Annual evaluations by the supervisor that take place with the individual/LAR ensures that the
needs of the individual are being met. Form 3599 is used to document this evaluation, as stated
in the instructions for the form. Documentation of habilitation and respite service provider
training outlined above must include a signed certificate of completion stating:
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Training topics covered;
Method of training (i.e., reading, video, discussion, etc.);
Name(s) and qualifications of instructor(s);
Name of the trainee;
Date the training was completed;
Signature and date of the instructor(s); and
Signature and date of the trainee verifying completion.
3132 Initial and Annual Training for All DSA Staff
Revision 13-2; Effective September 6, 2013
Within 60 calendar days of the employee beginning to work with the CLASS program and every
12 months, all direct service agency (DSA) staff must receive training on:
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Abuse, Neglect and Exploitation (ANE) Prohibited Against Individuals
o review of the statute on abuse, neglect and exploitation at Human Resources
Code, Chapter 48, §48.002 (2, 3 and 4);
o signs and symptoms of ANE;
o reporting requirements of ANE; and
o how to report abuse, neglect and exploitation to DFPS at
www.dfps.state.tx.us/Contact_Us/report_abuse.asp.
Rights and Responsibilities of Individuals
o information about the rights of the individual who receives CLASS services as
outlined in the DADS Consumer Rights and Services booklet; and
o review of CLASS rules in Chapter 45, Subchapter C, §45.301 and §45.302
concerning the Rights and Responsibilities of an Individual.
DSA staff who develop the curriculum used for initial and annual training must have attended
and successfully completed the CLASS Provider Training. Verification of a DSA training
instructor’s completion of CLASS Provider Training must be maintained and available to DADS
employees during a contract monitoring review. If a DSA develops curriculum to meet CLASS
training requirements, the curriculum and training materials used must be maintained by the
DSA and available to DADS employees during a contract monitoring review.
3133 Types of Habilitation Service Providers
Revision 13-2; Effective September 6, 2013
The two types of habilitation service providers are:
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Regular habilitation service providers who perform all of the habilitation services
available within their scope of competency; and
Special habilitation services providers who may be used to initiate services or prevent a
break in service.
3134 Qualifications of Habilitation Service Providers
Revision 13-2;
Habilitation services are performed by habilitation service providers who:
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are employed by the direct service agency; and
are not spouses of individuals and, if the individual is under 18, are not the parent.
3135 Required Training for Habilitation Service Providers
Revision 13-2; Effective September 6, 2013
Before or when services begin, the habilitation service provider must meet the supervisor or
other staff member qualified to train the habilitation service provider in the specific needs of the
individual at the individual’s home. The habilitation service provider receives a general
orientation with the full participation of the individual, if possible, in the habilitation activities
necessary to meet the needs and characteristics of the individual to whom the service provider is
assigned.
3135.1 Required Training for Certain Special Habilitation Service Providers
Revision 13-2; Effective September 6, 2013
Special habilitation service providers who have six continuous months of experience in
delivering habilitation services in any Medicaid program or program that primarily serves
individuals with intellectual disabilities can receive the orientation from the supervisor or other
appropriate DSA staff by phone rather than in person. Orientation of the service provider to the
specific needs of the individual must be documented on Form 3599, Habilitation Service
Provider Orientation/Supervisory Visits.
After the first orientation to the habilitation activities necessary to meet the needs and
characteristics of an individual, the habilitation service provider does not need to be reoriented if
the individual’s condition, tasks and hours remain unchanged. There are no limits on the length
of time a habilitation service provider may be used. The habilitation service provider may serve
the individual without retraining, as long as the individual’s condition, tasks and hours remain
unchanged. In addition, there are no restrictions with respect to the amount of time between the
habilitation service provider’s assignments.
3136 Documentation of Required Experience for Exception
Revision 13-2; Effective September 6, 2013
Records provided by the employee, or records provided by a former or current employer that
document the time the employee delivered direct care services, may be used to establish that a
special habilitation service provider meets requirements.
3200 Eligibility
Revision 12-1; Effective January 13, 2012
The DSA is responsible for verifying the individual's eligibility for the CLASS program by
ensuring the following criteria are met:
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the individual is determined by DADS to meet the diagnostic and functional eligibility
criteria for the CLASS program;
the individual has been diagnosed with a related condition that manifested before the
individual was age 22;
the individual demonstrates a need for habilitation;
the individual has an Individual Plan of Care (IPC) cost for CLASS program services at
or below $114,736.07, for an individual who meets the diagnostic eligibility criteria; and
the individual resides in his own home or family home. Note: An individual is not
considered to reside in his own home or family home if he is admitted to one of the
facilities outlined in Section 2430, Suspension, and Section 3430, Suspension, for more
than 180 consecutive calendar days.
Individuals who receive CLASS services must maintain continuous eligibility as outlined above.
The DSA must assess the individual at the time of enrollment, at least annually, and as necessary
when an individual's situation changes that may result in the individual no longer meeting all
CLASS eligibility criteria.
On a monthly basis, the DSA is responsible to verify the status of Medicaid eligibility for all
individuals served by the DSA. If an individual is found to be ineligible for Medicaid, the DSA
must notify the case manager no later than the next business day. The DSA must maintain
verifiable evidence of having completed these monthly checks and notifying the case manager.
CLASS services may be terminated if the individual does not meet all eligibility criteria as
outlined in Texas Administrative Code (TAC) §45.406. For more information regarding
termination of services, see Section 3400, Denial, Reduction, Suspension and Termination.
See Appendix V, ID/RC Processing, for additional information and detailed instructions for
DSAs.
3300 Service Planning
Revision 11-1;
A DSA must ensure a representative from their agency participates as a member of an
individual's service planning team (SPT). A DSA representative must be a:
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program director or meet program director qualifications;
registered nurse (RN); or
licensed vocational nurse (LVN).
Meetings of the SPT must be at a time and location that is mutually agreed upon by all
mandatory members.
The SPT should include, at a minimum, the applicant/LAR, case manager and a DSA
representative. The individual or LAR may request the SPT include professionals who are
qualified by certification or licensure, or training and experience in the habilitation needs of
people with related conditions, or directly involved in the delivery of services and supports to the
individual. If licensed or certified professionals attend the SPT meeting, this may be billed as a
professional service, only when the individual has an identified need for the service, and for
actual time spent in the capacity of the respective discipline. The SPT may include any other
people requested by the individual/LAR. The SPT will make every effort to accommodate these
requests by the individual/LAR.
After all requirements for eligibility are met, and at least annually thereafter, the case manager,
the applicant/individual/LAR, DSA representative(s) and other persons as requested by the
applicant/individual/LAR must meet to develop a proposed Form 3621, CLASS – Individual
Plan of Care.
The proposed IPC must specify:
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the type of CLASS program services to be provided to the individual;
the number of units of each CLASS program service;
the estimated annual cost of all CLASS program services; and
other services or supports to be provided to the individual through sources other than the
CLASS program.
The SPT will develop Form 8606, Individual Program Plan (IPP).
An IPP is needed for each CLASS service listed on the proposed IPC. Each IPP describes:
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the CLASS service to be provided;
the frequency of service provision;
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the duration of services;
observable and measurable goals and objectives;
the title of person responsible for implementing and monitoring goals and objectives;
justification for services based on needs identified by the SPT; and
support services provided through non-CLASS resources.
Each CLASS service must be provided to an individual in accordance with the individual's IPC
and the individual's IPP for that service. A DSA must inform the individual's case manager
throughout the IPC year of changes needed to the individual's IPC or IPPs.
On an ongoing basis, the DSA's responsibilities include:
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participating in the SPT;
developing the habilitation plan (only applicable to service(s) delivered through the
provider-managed service delivery option);
developing service backup plans for individuals receiving nursing and/or habilitation
services when the service planning team has determined the service is critical to an
individual’s health and safety (only applicable to nursing and/or habilitation service(s)
delivered through the provider-managed service delivery option);
if the service backup plan is implemented, discuss with the individual and the service
providers or natural supports identified in the service backup plan to determine whether
or not the plan was effective;
document whether or not the plan was effective,
revise the plan with input from the service planning team if the plan was determined to be
ineffective;
completing Form 8578, Intellectual Disability/Related Condition (ID/RC) Assessment,
submitting to DADS and providing additional information as requested by DADS for the
purposes of authorizing the individual's level of care;
delivering an array of CLASS services in accordance with the IPC and the IPP and in
coordination with non-CLASS services;
providing services to the individual as defined in the IPP;
implementing the individual's observable and measurable goals and objectives;
informing the individual of rights and responsibilities, including complaint procedures;
reporting the individual's changing needs and goals to the case manager;
working with community resources as necessary to ensure the provision of CLASS
services achieves the goal to provide flexible resources that increase personal
independence and integration into the community;
coordinating individual providers of service; and
documenting the provision of services and providing, upon request, a quarterly summary
of IPC service balances to the case manager.
3310 Enrollment
At the time an applicant receives a written offer of a CLASS program vacancy from DADS, the
applicant must select a DSA within 30 calendar days after the date of the written offer from
DADS. DADS notifies the selected DSA the applicant has chosen the agency to provide direct
services according to the DADS Selection Determination document.
The DSA must assign a registered nurse to perform and complete the following functions within
14 calendar days after receiving Form 3657, Pre-Enrollment Assessment, from the CMA, as
evidenced by the fax transmittal date on the documents received from the CMA.
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an initial face-to-face, in-home visit with the individual/LAR;
a nursing assessment of the individual using the CLASS/DBMD Nursing Assessment
form;
an adaptive behavior assessments of the individual, as outlined in Form 8578, Intellectual
Disability/Related Condition (ID/RC) Assessment instructions; and
the ID/RC Assessment in accordance with form instructions.
The DSA must ensure:
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the applicant's physician attests to the applicant's diagnosis on the ID/RC Assessment;
the completed ID/RC Assessment is submitted to DADS for approval within 30 days of
notification of completion of the Pre-Enrollment Assessment conducted by the CMA;
the DADS-approved ID/RC and the completed CLASS/DBMD Nursing Assessment is
transmitted to the applicant's CMA within one business day after receiving notification of
approval of the ID/RC from DADS; and
a DSA representative is available to participate in the applicant's enrollment SPT meeting
as convened by the case manager.
Form Resources
The following forms may need to be completed as part of the enrollment process:
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Form 2067, Case Information
Form 3590, CLASS – Nursing Assessment
Form 3596, CLASS/DBMD – Habilitation Plan
Form 3597, CLASS – Habilitation Training Plan
Form 3599, Habilitation Service Provider Orientation/Supervisory Visits
Form 3621, CLASS – Individual Plan of Care
Form 3625, CLASS – Documentation of Services Delivered
Form 3627, Specialized Nursing Certification
Form 3628, Provider Agency Model Service Backup Plan
Form 8578, Intellectual Disability/Related Condition Assessment
Form 8606, Individual Program Plan (IPP)
Submission Standard — ID/RC
The following submission standards apply when submitting ID/RC paperwork to DADS:
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Form 8578, Intellectual Disability/Related Condition Assessment
Form 8662, Related Conditions Eligibility Screening Instrument
ABL assessment scoring summary
Submission Standard — Pre-enrollment
The following submission standards apply when submitting paperwork containing funding
proposals for pre-enrolment efforts to DADS:
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Form 3625, CLASS – Documentation of Services Delivered
Form 8578, Intellectual Disability/Related Condition Assessment
3320 DSA Renewal
Continuing eligibility must be determined at least annually. As with the initial assessment, the
DSA RN is required to complete an annual nursing assessment of the individual using the
CLASS/DBMD Nursing Assessment form, a Form 8578, Intellectual Disability/Related
Condition (ID/RC) Assessment, a Form 8662, Related Conditions Eligibility Screening
Instrument (RCESI) (these documents must be completed every year), and an adaptive behavior
level (ABL) assessment if the current one is greater than five years old, or is no longer valid.
Form 8578, Form 8662 and results of the current ABL assessment must be sent to DADS at least
60 calendar days, but no more than 120 calendar days, before the expiration of an individual's
IPC to establish that an individual continues to meet diagnostic eligibility criteria. Once DADS
informs the DSA of the approval of diagnostic eligibility, the DSA must submit a copy of the
approved ID/RC and the completed CLASS/DBMD Nursing Assessment to the CMA by the
next business day.
If an individual's ABL assessment is more than five years old or the individual's needs
significantly change, the DSA must complete one of the following ABL assessments according
to the publisher's instructions:
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Inventory for Client and Agency Planning (ICAP);
Vineland Adaptive Behavior Scales, Second Edition (Vineland-II);
Scales of Independent Behavior – Revised (SIB-R); or
American Association of Intellectual and Developmental Disabilities (AAIDD) Adaptive
Behavior Scales (ABS).
A DSA representative, as defined in Section 3300, Service Planning, must participate as a
member of the SPT to develop:
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a renewal IPC — the CLASS program services on the proposed renewal IPC must meet
the following standards, which:
o are necessary to protect the individual's health and welfare in the community;
o address the individual's related condition;
o are not available to the individual through any other source including the
Medicaid state plan, other governmental programs, private insurance or the
individual's natural supports;
o are the most appropriate type and amount of CLASS program services to meet the
individual's needs; and
o are cost effective.
a renewal IPP for each service proposed on the renewal IPC;
a Form 3596, CLASS/DBMD – Habilitation Plan, and Form 3597, CLASS – Habilitation
Training Plan (if applicable); and
a service backup plan for the following services, if delivered by the DSA:
o habilitation services if the service planning team determines the service is critical
to the individual's health and safety;
o habilitation delegated if the service planning team determines the service is
critical to the individual's health and safety; and
o nursing services, if the service planning team determines the service is critical to
the individual's health and safety.
CLASS program services as a whole enhance an individual's integration in the community and
prevent admission to an institution while maintaining and improving independent functioning.
The DSA is responsible for assisting and providing documentation, as requested by the CMA.
Form Resources
The following forms may need to be completed as part of the renewal process:
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Form 1740, Service Backup Plan
Form 2067, Case Information
Form 3596, CLASS/DBMD – Habilitation Plan
Form 3597, CLASS – Habilitation Training Plan
Form 3598, CLASS – Individual Transportation Plan
Form 3621, CLASS – Individual Plan of Care
Form 3625, CLASS – Documentation of Services Delivered
Form 3628, Provider Agency Model Service Backup Plan
Form 8578, Intellectual Disability/Related Condition Assessment (Page 1 and Page 3)
Form 8598, Non-Waiver Services
Form 8606, Individual Program Plan (IPP)
Form 8662, Related Conditions Eligibility Screening Instrument
Submission Standard
The following submission standards apply when submitting ID/RC paperwork to DADS:
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Form 8578, Intellectual Disability/Related Condition Assessment
Form 8662, Related Conditions Eligibility Screening Instrument
ABL assessment scoring summary
3330 Revision
Revision 13-2; Effective September 6, 2013
When the DSA is notified of a needed revision to the IPC, the DSA representative must contact
the CMA within one business day. The DSA is responsible for assisting and providing
documentation, as requested by the CMA to ensure:
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a proposed IPC revision includes an IPP for each service revised on the proposed IPC and
a revised Form 3596, CLASS/DBMD – Habilitation Plan, if applicable;
CLASS services as a whole enhance an individual's integration in the community and
prevent admission to an institution while maintaining and improving independent
functioning; and
the CLASS services on the proposed IPC revision must meet the following standards:
o are necessary to protect the individual's health and welfare in the community;
o address the individual's related condition;
o are not available to the individual through any other source including the
Medicaid state plan, other governmental programs, private insurance or the
individual's natural supports;
o are the most appropriate type and amount of CLASS program services to meet the
individual's needs; and
o are cost effective.
Within five business days after receipt of the IPP and IPC from the CMA, as evidenced by the
fax transmittal date on the documents received from the CMA, the DSA must sign and return the
IPP and IPC to the CMA. If any revised services provided by the DSA affect the service backup
plan, habilitation plan or habilitation training plan, the DSA must revise the existing plan to
reflect these changes to program services.
3331 Immediate Jeopardy
Revision 11-1; Effective June 13, 2011
Immediate jeopardy is interpreted as a crisis situation in which the health and safety of an
individual is at risk.
During circumstances when the individual's health and safety is placed in immediate jeopardy
the DSA must provide the following services:
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licensed vocational nursing;
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specialized licensed vocational nursing;
registered nursing;
specialized registered nursing;
habilitation;
respite;
dental treatment; or
adaptive aid.
These services must be provided even if they are not included on the individual's IPC. The DSA
must, within seven calendar days after providing the service, submit to the CMA:
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a description of circumstances necessitating the provision of the new service or the
increase in the amount of the existing service; and
documentation by a registered nurse of the nurse's determination the service was
necessary to prevent the individual's health and safety from being placed in immediate
jeopardy.
Form Resources
The following forms may need to be completed as part of the revision process:
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Form 1740, Service Backup Plan
Form 2067, Case Information
Form 3596, CLASS/DBMD – Habilitation Plan
Form 3597, CLASS – Habilitation Training Plan
Form 3598, CLASS – Individual Transportation Plan
Form 3621, CLASS – Individual Plan of Care
Form 3628, Provider Agency Model Service Backup Plan
Form 8606, Individual Program Plan (IPP)
3340 Transfer
Revision 11-1; Effective June 13, 2011
If an individual plans to move to another CLASS provider, the case manager must provide the
individual the most current Selection Determination document for the applicable catchment area.
The requirements for the transferring DSA and receiving DSA are provided below.
3341 Transferring DSA
Revision 11-1;
The transferring DSA must provide the receiving DSA with the current balance of each service
category based on most current IPC authorized and actual delivery up to the transfer effective
date — Form 3621-T, CLASS – IPC Service Delivery Transfer Worksheet. The total number of
service units provided before the effective date of the transfer is the sum of the number of service
units:
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provided and paid,
provided that have been billed but not yet paid, and
to be provided until the transfer effective date.
Copies of the identified records must be delivered by the transferring DSA to the receiving DSA
within five calendar days of notification by the case manager of the individual's decision to
transfer to a different DSA. The records that must be provided include:
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current IPC;
current SPT notes;
current IPP;
current Form 8578, Intellectual Disability/Related Condition Assessment;
current Form 8662, Related Conditions Eligibility Screening Instrument;
current Form 3596, CLASS/DBMD – Habilitation Plan;
current Form 3597, CLASS – Habilitation Training Plan, if applicable;
records of all adaptive aids purchased during the current IPC period;
records of all minor home modifications procured for the individual, regardless of date of
purchase and cost of each;
all quarterly reviews performed by the DSA during the current IPC period;
current physician's orders;
copies of DSA records for 90 calendar days prior to DSA transfer, including:
o habilitation;
o medication administration record;
o money management;
o assessments and notes for any services listed on the IPC; and
o all communications, including:
 contact notes;
 progress notes;
 Form 2067, Case Information;
 Forms 3624, Termination, Reduction or Denial of CLASS;
 incident reports; and
 complaints;
school/day programming information including:
o Admission, Review and Dismissal (ARD) notes; and
o Individual Education Plan (IEP); and
current service delivery schedules for all services.
The transferring DSA is required to maintain documentation of the specific records that were
delivered to the receiving DSA, as well as the date of the delivery.
3342 Receiving DSA
Revision 11-1; Effective June 13, 2011
The receiving DSA must initiate services on the transfer effective date, as identified on Form
3621-T, CLASS – IPC Service Delivery Transfer Worksheet. The total number of service units
available to the receiving DSA is the number of service units to be provided from the transfer
effective date until the end of the IPC effective period.
The receiving DSA must develop a Form 3628, Provider Agency Model Service Backup Plan,
for those services requiring a backup plan as indicated on the IPC.
3350 IPP Service Summaries
Revision 13-2;
CLASS service provider(s) must evaluate the effectiveness of CLASS services delivered by the
Direct Service Agency (DSA). The DSA is responsible for providing an Individual Program Plan
(IPP) Service Summary to the CMA in accordance with the schedule in Appendix X, IPP Service
Summary and Service Review Due Dates Chart, of the CLASS Provider Manual from the
effective date of the most recent enrollment or renewal IPC. The final review of the IPC year is
combined with the meeting of the Service Planning Team (SPT) to develop a renewal IPC. The
case manager is responsible for documenting the service summary provided by the DSA since
the preceding review. The evaluation must include an assessment of the individual's progress,
evolving needs, and plans to address those needs. The IPP Service Summary must document the
service provider’s review of the individual's progress toward achieving the goals and objectives
as described on the IPP for each CLASS Program service listed on the individual's IPC. There is
not a DADS form for the IPP Service Summary; however, the DSA must provide this
information in a written format.
A DSA is required to ensure that each CLASS Program service is provided to an individual in
accordance with Appendix C of the CLASS waiver application available on the CLASS website
at: http://www.dads.state.tx.us/providers/CLASS/index.cfm .
An IPP is developed to describe the goals and objectives to be met by the provision of each
CLASS service on an individual's IPC that are supported by justifications, are measurable; and
have timelines. Additionally, a DSA must ensure CLASS services are documented in the
individual's record, including the progress or lack of progress in achieving goals or outcomes in
observable, measurable terms that directly relate to the specific goal or objective addressed.
The DSA must provide the case manager with summaries of each service provided by the DSA
documenting the individual's progress and needs.
Within five business days of completing the quarterly service summary, the DSA is responsible
for providing copies of the summaries to the case manager, as evidenced by the fax transmittal
date on the documents provided to the CMA. The DSA must maintain documentation of
transmission of all necessary documents. A quarterly service summary for each service listed
below must be prepared in the second, fifth and eighth months from the effective date of the
most recent enrollment or renewal IPC. The DSA verbally updates the case manager during the
renewal Service Planning Team (SPT) meeting with any relevant information regarding services
delivered in the last quarter of the IPC year.
The summaries must include quarterly reports from providers of the following services:

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auditory enhancement training;
behavioral support;
dietary services (nutritional services);
habilitation training;
occupational therapy;
physical therapy;
prevocational services;
specialized therapies;
speech and language pathology; and
supported employment services.
Each IPP Service Summary completed bythe service provider must include all of the elements
listed below:


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current observable/measurable goals and objectives;
frequency and duration of sessions attended;
rationale for missed sessions;
progress or lack of progress;
actions taken, as applicable (e.g., in-servicing, counseling, etc.); and
revisions of goals and objectives, as applicable.
Form Resources
The following forms may need to be completed as part of the summary:


Form 2067, Case Information
Form 3621, CLASS – Individual Plan of Care
3400 Denial, Reduction, Suspension and Termination
Revision 13-2; Effective September 6, 2013
An individual who has been denied enrollment or terminated from the CLASS program, or an
individual whose CLASS program services are denied, reduced, suspended or terminated must
be given notice of adverse actions taken by DADS and is entitled to a fair hearing.
3410 Denial
Revision 11-1; Effective June 13, 2011
Denial is a DADS action that disallows:



an individual's request for enrollment in the CLASS program;
a service requested on the IPC that was not authorized on the prior IPC; or
a portion of the amount or level of the service requested on the IPC that was not
authorized on the prior IPC.
3411 Denial of a Request for Enrollment into the CLASS Program
Revision 13-2; Effective September 6, 2013
DADS denies an individual's request for enrollment into the CLASS program if:


the individual does not meet the eligibility criteria described in §45.201, Eligibility
Criteria; or
the DSAs serving the catchment area in which the individual resides are not willing to
provide CLASS program services to the individual because they have determined they
cannot ensure the individual's health and safety.
If DADS denies an individual's request for enrollment, DADS sends written notice to the
individual or LAR of the denial of the individual's request for enrollment into the CLASS
program and includes in the notice the individual's right to request a fair hearing in accordance
with §45.301, Individual's Right to a Fair Hearing. DADS sends a copy of the written notice to
the individual's DSA, CMA and, if selected, Financial Management Services Agency (FMSA).
3412 Denial of a CLASS Program Service
Revision 11-1; Effective June 13, 2011
CLASS program services as a whole enhance an individual's integration in the community and
prevent admission to an institution while maintaining and improving independent functioning.
DADS denies a CLASS program service on an individual's IPC if services:
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are not necessary to protect the individual's health and welfare in the community;
do not address the individual's related condition;
are available to the individual through any other source including the Medicaid state plan,
other governmental programs, private insurance or the individual's natural supports;
are not the most appropriate type and amount of CLASS program services to meet the
individual's needs; or
are not cost effective.
If DADS determines one or more of the CLASS program services specified in the IPC do not
meet the requirements for an IPC, DADS:

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
denies or reduces the service(s), as appropriate;
modifies and authorizes the IPC; and
notifies the individual's CMA, in writing, of the action taken.
Form Resources
The following forms may need to be completed as part of a denial of services:



Form 2067, Case Information
Form 3624, Termination, Reduction or Denial of CLASS
Form 4800-D, Fair Hearing Request Summary
3420 Reduction
Revision 11-1; Effective June 13, 2011
Reduction is a DADS action taken as a result of a review of an IPC that decreases the amount or
level of a service authorized by DADS on a prior IPC.
DADS will perform a utilization review on all IPCs that meet criteria outlined in Section 5000,
Utilization Review (UR). All services and units of service included on a proposed IPC must be
justified by the SPT.
CLASS Operations staff review the IPC to ensure the services on the IPC:

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are necessary to protect the individual's health and welfare in the community;
supplement rather than replace the individual's natural supports and other non-CLASS
program services and supports for which the individual may be eligible;
CLASS program services as a whole enhance an individual's integration in the
community and prevent admission to an institution while maintaining and improving
independent functioning;
are the most appropriate type and amount of services to meet the individual's needs; and
are cost effective.
As necessary during the review of a proposed IPC, CLASS Operations staff will ask case
managers to provide additional justification if the initial information submitted with a proposed
IPC is not sufficient to demonstrate the need for a proposed service(s). If information submitted
to DADS by the case manager does not provide sufficient information to justify requested
services or amounts of services, DADS will reduce the number of units of services, as necessary,
and will notify the CMA of the reduction in writing.
If an individual's services are reduced, the DSA is notified by the CMA in writing describing
DADS reason for the reduction. The DSA is also notified by the CMA if and when the individual
chooses to appeal the decision. If the individual or LAR requests a fair hearing within 10 days
from date of notification, as specified in the written notice, the DSA must provide the service to
the individual in the amount authorized in the prior IPC while the appeal is pending.
Form Resources
The following forms may need to be completed as part of a reduction of services:



Form 2067, Case Information
Form 3624, Termination, Reduction or Denial of CLASS
Form 4800-D, Fair Hearing Request Summary
3430 Suspension
Revision 11-1; Effective June 13, 2011
Suspension is a DADS action that results in temporary loss of the individual's authorized
services in the CLASS program. An individual may remain on suspension from CLASS for up to
180 calendar days. DADS may extend an individual's suspension for 30 calendar days upon the
CMA's request.
Suspension is a DADS action taken as a result of:


an individual's admission, for up to180 consecutive calendar days, to one of the following
facilities:
o an ICF/IID licensed or subject to being licensed in accordance with Texas Health
and Safety Code, Chapter 252, or certified by DADS, unless the individual is
receiving out-of-home respite in the facility;
o a nursing facility licensed or subject to being licensed in accordance with Texas
Health and Safety Code, Chapter 242, unless the individual is receiving out-ofhome respite in the facility;
o an assisted living facility licensed or subject to being licensed in accordance with
Texas Health and Safety Code, Chapter 247;
o a residential child-care operation licensed or subject to being licensed by the
Department of Family and Protective Services (DFPS), unless it is a foster family
home or a foster group home;
o a facility licensed or subject to being licensed by the Department of State Health
Services (DSHS);
o a facility operated by the Department of Assistive and Rehabilitative Services
(DARS);
o a residential facility operated by the Texas Youth Commission; or
o a jail or prison;
an individual leaving the state for up to 180 consecutive calendar days.
Within two business days of learning of a situation that necessitates an individual's CLASS
program services to be suspended, the DSA must send the CMA written notification using Form
2067, Case Information, including any supporting documentation.
Form Resources
The following forms may need to be completed as part of a suspension of services:



Form 2067, Case Information
Form 3624, Termination, Reduction or Denial of CLASS
Form 4800-D, Fair Hearing Request Summary
3440 Termination
Revision 11-1; Effective June 13, 2011
Termination is a DADS action that results in the loss of the individual's eligibility for authorized
services in the CLASS program.
3441 Termination With Advanced Notice
DADS terminates an individual's CLASS program services if:
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the individual does not meet program eligibility criteria;
the individual is admitted for more than 180 consecutive calendar days to one of the
following facilities:
o an ICF/IID licensed or subject to being licensed in accordance with Texas Health
and Safety Code, Chapter 252, or certified by DADS, unless the individual is
receiving out-of-home respite in the facility;
o a nursing facility licensed or subject to being licensed in accordance with Texas
Health and Safety Code, Chapter 242, unless the individual is receiving out-ofhome respite in the facility;
o an assisted living facility licensed or subject to being licensed in accordance with
Texas Health and Safety Code, Chapter 247;
o a residential child-care operation licensed or subject to being licensed by DFPS,
unless it is a foster family home or a foster group home;
o a facility licensed or subject to being licensed by DSHS;
o a facility operated by DARS; or
o a residential facility operated by the Texas Youth Commission, a jail or prison;
the individual leaves the state for more than 180 consecutive calendar days and DADS
has not extended the individual's suspension;
DSAs serving the catchment area in which the individual resides are not willing to
provide CLASS program services to the individual on the basis of a reasonable
expectation that the individual's medical and nursing needs cannot be met adequately in
the individual's residence; or
the individual refuses to comply with one or more of the mandatory participation
requirements as follows:
o
o
o
o
o
o
o
o
o
o
o
o
o
not completing and submitting an application for Medicaid financial eligibility to
Health and Human Services Commission (HHSC) within 30 calendar days after
the case manager's initial face-to-face, in-home visit (Note: If an individual or
LAR does not submit a Medicaid application to HHSC within 30 calendar days of
the case manager's initial face-to-face, in-home visit as required, but is making
good faith efforts to complete the application, DADS may extend this time frame
in 30 calendar-day increments.);
not participating with the SPT to:
 develop an enrollment IPC; or
 renew and revise the IPC and IPPs;
not reviewing, agreeing to, signing and dating an IPC and IPPs;
not using natural supports and other non-CLASS services and supports for which
the individual may be eligible before using CLASS services;
not cooperating with the CMA and DSA in the delivery of CLASS services listed
on the individual's IPC, including:
 not cooperating with the CMA and DSA in scheduling meetings;
 not attending scheduled meetings with the case manager or service
provider;
 not being available to receive the CLASS services;
 not notifying the CMA or DSA in advance if the individual or LAR is
unable to attend a scheduled meeting or is unavailable to receive services
in the individual's own or family home;
 not admitting CMA and DSA representatives to the individual's own home
or family home for a scheduled meeting or to receive CLASS services;
not cooperating with the DSA's service providers to ensure progress toward
achieving the goals and objectives described in the IPP for each CLASS service
listed on the IPC;
not paying a required copayment in a timely manner as required by HHSC;
not completing the procedures for redetermining eligibility for Medicaid as
described in the Medicaid for the Elderly and People with Disabilities Handbook;
engaging or permitting a person present in the individual's own or family home to
engage in criminal behavior in the presence of the case manager or service
provider;
acting or permitting a person present in the individual's own or family home to act
in a manner that is threatening to the health and safety of the case manager or
service provider;
exhibiting behavior or permitting a person present in the individual's residence to
exhibit behavior that places the health and safety of the case manager or service
provider in immediate jeopardy;
initiating or participating in fraudulent health care practices; or
engaging or permitting a person present in the individual's own home or family
home to engage in behavior that endangers the individual's health or safety.
Within two business days after the DSA learns of one of the situations described above, the DSA
must send the CMA a written notification per Form 2067, Case Information, including
supporting documentation. The DSA is responsible for making reasonable attempts to
accommodate a face-to-face meeting with the SPT as scheduled by the CMA.
If termination of services is requested based on a determination by the DSA on the basis of a
reasonable expectation that the individual's medical and nursing needs cannot be met adequately
in the individual's residence, the DSA must provide specific reason(s) to the CMA regarding why
the DSA determined it cannot ensure the individual's health and safety.
DADS notifies the individual's CMA, in writing, of whether it authorizes the proposed
termination of CLASS program services. The DSA is notified by the CMA regarding the
termination.
If CLASS program services are terminated due to an individual's IPC cost being over 200% of
the estimated annualized per capita cost of providing services in an ICF/IID, DADS sends
written notice to the individual or LAR of the proposal to terminate CLASS program services
and includes in the notice the individual's right to request a fair hearing. DADS sends a copy of
the written notice to the individual's DSA, CMA and, if selected, FMSA.
DADS notifies the individual's CMA, in writing, of whether it authorizes the proposed
termination of CLASS program services. The DSA is notified by the CMA regarding the
termination.
If the individual or LAR requests a fair hearing before the effective date of a proposed
termination of CLASS program services, the DSA must provide services to the individual in the
amounts authorized in the IPC while the appeal is pending.
3442 Termination Without Advanced Notice
Revision 11-1; Effective June 13, 2011
DADS terminates an individual's CLASS program services without advanced notice if any of the
following situations exist:
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the CMA or DSA has factual information confirming the death of the individual;
the CMA or DSA receives a clearly written statement signed by the individual that the
individual no longer wishes to continue to receive CLASS program services;
the individual's whereabouts are unknown and the post office returns mail directed to him
or her by the CMA or DSA, indicating no forwarding address;
the CMA or DSA establishes the individual has been accepted for Medicaid services by
another state; or
an individual or a person in the individual's residence exhibits behavior that places the
health and safety of the CMA's case manager or a DSA's service provider in immediate
jeopardy. For more information, see Section 3510, Immediate Jeopardy.
Within two business days after the DSA becomes aware of a situation such as described above,
the DSA must send the CMA a written notification per Form 2067, Case Information, including
supporting documentation.
DADS notifies the individual's CMA, in writing, of whether it authorizes the termination of
CLASS services. The DSA is notified by the CMA regarding the termination.
DADS may terminate an individual's CLASS services if an individual or a person in the
individual's residence exhibits behavior that places the health and safety of the case manager or a
service provider in immediate jeopardy.
If a CMA or DSA becomes aware a situation exists that places the health and safety of the
individual's case manager or service provider in immediate jeopardy, the CMA or DSA must:
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immediately file a report with the appropriate law enforcement agency and, if
appropriate, make an immediate referral to DFPS;
notify the CMA or DSA, as appropriate, and DADS by telephone of the situation no later
than the next business day; and
attempt to resolve the situation.
DADS notifies the individual's CMA, in writing, of whether it authorizes the proposed
termination of CLASS services. The DSA is notified by the CMA regarding the termination.
Form Resources
The following forms may need to be completed as part of termination of services:
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Form 2067, Case Information
Form 3624, Termination, Reduction or Denial of CLASS
Form 4800-D, Fair Hearing Request Summary
3500 Service Initiation
Revision 11-1; Effective June 13, 2011
A DSA must ensure each CLASS service is provided to an individual in accordance with the
individual's IPC and IPP for each service.
A DSA must have a written process that ensures staff members are or can readily become
familiar with individuals to whom they are not ordinarily assigned but to whom they may be
required to provide a CLASS service.
A DSA must inform the individual's case manager of changes needed to the individual's IPC or
IPPs.
3510 Immediate Jeopardy
Revision 11-1; Effective June 13, 2011
Immediate jeopardy is interpreted as a crisis situation in which the health and safety of an
individual is at risk.
During circumstances when the individual's health and safety is placed in immediate jeopardy,
the DSA must provide the following services:
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licensed vocational nursing;
specialized licensed vocational nursing;
registered nursing;
specialized registered nursing;
habilitation;
respite;
dental treatment; or
adaptive aid.
These services must be provided even if they are not included on the individual's IPC, if a
registered nurse determines the service is necessary to prevent the individual's health and safety
from being placed in immediate jeopardy. In such an event, the DSA must, within seven calendar
days after providing the service, submit to the CMA:
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
documentation describing the circumstances necessitating the provision of the new
service or the increase in the amount of the existing service; and
documentation by an RN of the nurse's determination the service was necessary to
prevent the individual's health and safety from being placed in immediate jeopardy.
The CMA must use the date of the documentation provided by the DSA RN of the circumstances
surrounding the determination of immediate jeopardy as the IPC eff date. DADS authorizes the
IPC once submitted by the CMA only if DADS determines the service was necessary to prevent
the individual's health and safety from being placed in immediate jeopardy.
DADS notifies the DSA, through the online billing system, of whether the proposed IPC is
authorized.
3520 Adaptive Aids Costing Less than $500
Revision 11-1; Effective June 13, 2011
Once the DSA has determined the cost of the requested adaptive aid, the DSA must request in
writing the case manager initiate an IPC revision. The DSA must inform the individual's case
manager of the cost of the requested adaptive aid.
DADS authorizes the IPC once submitted by the CMA if, after reviewing the documentation, it
determines the requested adaptive aid meets the standards outlined in Appendix I, Adaptive
Aids.
The DSA must ensure the individual receives the adaptive aid within 14 business days after the
date DADS authorizes the proposed IPC that includes the recommended adaptive aid; or the
effective date of the individual's IPC as determined by the SPT (whichever is later). The DSA
must complete Form 8605 that serves as the primary document for purchases of authorized
adaptive aids/medical supply items or minor home modifications made by the service provider
for individuals.
For an adaptive aid that is a medical supply, a DSA must ensure the individual receives the
medical supply as follows:
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
for a medical supply that is not immediately needed by the individual, within five
business days after the date DADS authorizes the proposed IPC that includes the
recommended adaptive aid; or the effective date of the individual's IPC as determined by
the SPT (whichever is later); or
for a medical supply that is immediately needed by the individual, within two business
days after the date DADS authorizes the IPC that includes the recommended adaptive aid.
If the DSA cannot provide the adaptive aid in the time frame described, the DSA must:
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notify the individual and the individual's case manager, orally or in writing, before the
14-day time frame expires, that the adaptive aid will not be provided within the 14-day
time frame; and
notify the individual and the individual's case manager of a new proposed date for
provision of the adaptive aid.
If the DSA cannot provide an adaptive aid that is a medical supply and is not immediately
necessary by the individual, the DSA must:
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notify the individual and the individual's case manager, orally or in writing, before the
five-day time frame expires, that the adaptive aid will not be provided within the five-day
time frame;
provide the reason(s) why the medical supply will not be provided within the five-day
time frame; and
notify the individual and the individual's case manager of a new proposed date for
provision of the medical supply.
3530 Adaptive Aid Costing $500 or More
Revision 13-2;
Once the Service Planning Team (SPT) has agreed the applicant/individual is in need of an
adaptive aid with an anticipated cost that is more than $500, the direct service agency (DSA)
must request in writing that the case manager initiate an individual plan of care (IPC) revision
including funds for obtaining an assessment of the individual by the appropriate licensed
professional, practicing within the scope of his/her licensure, that includes a description and a
recommendation for an adaptive aid that meets the individual’s need(s). This assessment must
identify how this adaptive aid will meet the needs of the individual and must include
consideration of other alternatives known to the appropriate licensed professional to meet the
individual’s need(s). Detailed descriptions, to the extent possible, must accompany the licensed
professional’s recommendation for adaptive aids when the cost is more than $500.
After DADS authorizes the proposed IPC for payment of the adaptive aid assessment, the DSA
must obtain the assessment from the appropriate licensed professional that describes the adaptive
aid within 30 calendar days. The assessment by the licensed professional that describes the
specific need(s) of the individual must include recommendations for the adaptive aid that, in the
opinion of the licensed professional, will best meet the needs identified in the assessment.
Based on the recommendations contained in the assessment, the DSA will consult with the most
appropriate person to determine the most cost-effective item(s) that meet the recommendations in
the assessment. The description of the item(s) as contained in the assessment must be used to
develop the specifications to obtain bids from vendors. The DSA must obtain comparable bids
for the requested adaptive aid from three vendors within 60 calendar days of obtaining the
specifications.
A bid obtained must be based on the specifications and include:
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the total cost of the requested adaptive aid, which may be from a catalog, website or
brochure price list;
the amount of any additional expenses related to the delivery of the adaptive aid,
including shipping and handling, taxes, installation and other labor charges;
the date of the bids;
the name, address and telephone number of the vendor, who may not be a relative of the
individual;
a complete description of the adaptive aid and any associated items or modifications as
identified in the completed Form 3660, Request for Adaptive Aids, Medical Supplies,
Minor Home Modifications or Dental Services/Sedation, which may include pictures or
other descriptive information from a catalog, website or brochure; and
the number of hours of the service or training to be provided in person and the hourly rate
of the service for interpreter services and specialized training for augmentative
communication programs.
The DSA must:
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
obtain the assessment from a licensed professional for the adaptive aid as described in
Appendix I, Adaptive Aids;
ensure the assessment includes a complete description of the adaptive aid; and

provide a copy of the assessment and the specifications to the CMA.
The Case Management Agency (CMA), Direct Services Agency (DSA), and individual/LAR
must complete and sign Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor
Home Modifications to signify agreement with the specifications.
The DSA may obtain only one bid or two comparable bids for an adaptive aid if the DSA has
written justification for obtaining less than three bids because the adaptive aid is available from a
limited number of vendors.
A bid obtained must be based on the specifications and include:






the total cost of the requested adaptive aid, which may be from a catalog, website or
brochure price list;
the amount of any additional expenses related to the delivery of the adaptive aid,
including shipping and handling, taxes, installation and other labor charges;
the date of the bid;
the name, address and telephone number of the vendor, who may not be a relative of the
individual;
a complete description of the adaptive aid and any associated items or modifications as
identified in the completed Form 3660, Request for Adaptive Aids, Medical Supplies,
Minor Home Modifications or Dental Services/Sedation, which may include pictures or
other descriptive information from a catalog, website or brochure; and
the number of hours of the service or training to be provided in person and the hourly rate
of the service for interpreter services and specialized training for augmentative
communication programs
A DSA may obtain only one bid or two comparable bids for an adaptive aid if the DSA has
written justification for obtaining less than three bids because the adaptive aid is available from a
limited number of vendors.
If a DSA requests to purchase an adaptive aid that is not based on the lowest bid, the DSA must
have written justification for payment of a higher bid. The following are examples of
justifications that support payment of a higher bid:


the higher bid is based on the inclusion of a longer warranty for the adaptive aid; and
the higher bid is from a vendor that is more accessible to the individual than another
vendor.
Requests for interpreter services or specialized training for augmentative communication devices
must include:


the total number of hours of the service or training to be provided in-person; and
the hourly rate of the service.
If the requested adaptive aid is a vehicle modification, a DSA must obtain proof the individual or
individual's family member owns the vehicle for which the vehicle modification is requested.
Requests for vehicle modifications to accommodate modifications or additions to the primary
transportation vehicle must include an assessment by the appropriate licensed professional as
indicated in Appendix I.
A DSA may not disclose information regarding a submitted bid to any other vendor who has
submitted a bid or to a vendor who may submit a bid.
The DSA must request in writing the case manager initiate an IPC revision. At this point, the
DSA must inform the individual's case manager of the cost of the requested adaptive aid.
DADS authorizes the IPC once submitted by the CMA if, after reviewing the documentation, it
determines the requested adaptive aid meets the standards outlined in Appendix I, Adaptive
Aids.
The DSA must ensure the individual receives the adaptive aid within 30 business days after the
date DADS authorizes the proposed IPC that includes the recommended adaptive aid; or the
effective date of the individual's IPC as determined by the SPT (whichever is later). The DSA
must complete Form 8605 that serves as the primary document for purchases of authorized
adaptive aids/medical supply items or minor home modifications made by the service provider
for individuals.
For an adaptive aid that is a medical supply, the DSA must ensure the individual receives the
medical supply as follows:


for a medical supply that is not immediately needed by the individual, within five
business days after the date DADS authorizes the proposed IPC that includes the
recommended adaptive aid; or the effective date of the individual's IPC as determined by
the service planning team (whichever is later); or
for a medical supply that is immediately needed by the individual, within two business
days after the date DADS authorizes the IPC that includes the recommended adaptive aid.
If the DSA cannot provide the adaptive aid in the time frame described, the DSA must:


notify the individual and the individual's case manager, orally or in writing, before the
30-day time frame expires, the adaptive aid will not be provided within the 30-day time
frame; and
notify the individual and the individual's case manager of a new proposed date for
provision of the adaptive aid.
For an adaptive aid that is a medical supply and not immediately needed by the individual, the
DSA must:
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notify the individual and the individual's case manager, orally or in writing, before the
five-day time frame expires the adaptive aid will not be provided within the five-day time
frame;
provide the reasons why the medical supply will not be provided within the five-day time
frame; and
notify the individual and the individual's case manager of a new proposed date for
provision of the medical supply.
3540 Minor Home Modification
Revision 13-2; Effective September 6, 2013
Once the Service Planning Team (SPT) has agreed the applicant/individual might require a
minor home modification, the direct service agency (DSA) must request in writing that the case
manager initiate an individual plan of care (IPC) revision that includes funds for obtaining an
assessment of the individual by the appropriate licensed professional to determine the specific
minor home modification necessary to meet the needs of the individual, as defined in the
assessment.
Once DADS notifies a DSA through the electronic billing system of a service authorization for
an assessment by the appropriate licensed professional of the individual’s need(s), the DSA must
obtain the assessment within 30 calendar days after the date DADS authorizes the IPC.
After DADS authorizes the proposed IPC for payment for the assessment of the individual, the
DSA must obtain the specifications from a person who has experience in home modifications
within 30 calendar days.
The DSA must:
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obtain an assessment of the individual from a licensed professional that describes the
specific minor home modification, as described in Appendix II, Minor Home
Modification Services. The assessment must include a complete description of the
specific need(s) of the individual and recommendations for the minor home modification
that will meet the needs identified in the assessment.
provide a copy of the assessment to the CMA.
obtain the specifications from a person who has experience in constructing home
modifications, based on the assessment completed by the professional.
ensure the specifications meet the following standards:
o include a complete description of the minor home modification and any required
installations identified in the specifications;
o include a drawing or picture of both the existing room, structure or other area and
the proposed modification made to scale;
o
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be approved in writing by each member of the SPT by completing Form 3849-A,
Specifications for Adaptive Aids/Medical Supplies/Minor Home Modifications;
and
o comply with the Texas Accessibility Standards promulgated by the Texas
Department of Licensing and Regulation unless:
 DSA determines it is not structurally feasible to do so and the DSA
documents, in writing, the basis for its determination; or
 the individual or LAR requests, in writing, the specifications not be in
compliance with the Texas Accessibility Standards;
be approved, in writing, by the individual or LAR and the DSA by completing Form
3849-A, as described in Appendix II; and
provide a copy of the specifications to the CMA.
The Case Management Agency (CMA), Direct Services Agency (DSA), and individual/LAR
must complete and sign Form 3849-A, Specifications for Adaptive Aids/Medical Supplies/Minor
Home Modifications to signify agreement with the specifications.
The DSA must obtain comparable bids for a minor home modification from three vendors if the
modification costs more than $1,000, within 60 calendar days after obtaining the specifications.
A bid obtained must be based on the specifications and include:
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an itemized list of materials and labor necessary to construct the modification;
the cost of each material and labor listed;
the date of the bid;
the name, address and telephone number of the vendor, who may not be a relative of the
individual;
a detailed explanation of the vendor's warranty for the modification, if any; and
a statement that the minor home modification will be made in accordance with all
applicable state and local building codes.
A DSA may obtain one bid or two comparable bids for a minor home modification if the DSA
has written justification for obtaining less than three bids because the minor home modification
is available from a limited number of vendors.
If a DSA requests to purchase a minor home modification that is not based on the lowest bid, the
DSA must have written justification for payment of a higher bid. The following are examples of
justifications that support payment of a higher bid:
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the higher bid is based on the inclusion of a longer warranty for the minor home
modification; and
the higher bid is from a vendor that is more accessible to the individual than another
vendor.
The person who developed the specifications may also offer one of the bids. A DSA may not
disclose information regarding a submitted bid to any other vendor who has submitted a bid or to
a vendor who may submit a bid.
After the DSA has successfully obtained a sufficient number of bids, the DSA must:
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select a vendor to complete construction of the minor home modification;
obtain written approval for construction of the modification from the owner of the
property in question, unless such approval is granted in an applicable lease agreement;
ensure the selected vendor obtains any required building permits; and
advise the CMA regarding the cost of the minor home modification and the cost of the
inspection of the modification, so that an IPC revision can be initiated.
Once DADS notifies a DSA through the electronic billing system of a service authorization for a
planned minor home modification and the cost of the inspection of the modification, the DSA
must direct the vendor to begin construction of the modification within seven calendar days after
the date DADS authorizes the proposed IPC; or the effective date of the IPC as determined by
the SPT (whichever is later).
A DSA must ensure a minor home modification is completed within 60 calendar days after the
date DADS authorizes the proposed IPC that includes the cost of the modification and inspection
or the effective date of the IPC as determined by the SPT (whichever is later).
If the DSA determines the minor home modification will not be completed within the time frame
required, the DSA must notify the individual or LAR in writing of a new proposed date of
completion. The proposed date may not exceed 30 calendar days after the date outlined before.
The DSA must conduct an in-person inspection of the minor home modification within seven
business days after it receives information the modification is completed. The inspection may be
performed by the person who developed the specifications unless that person is affiliated with
the vendor who completed the minor home modification. The inspection will determine if the:
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minor home modification has been completed;
modification has been made in accordance with the specifications; and
quality of workmanship of the modification is adequate.
If the DSA determines the minor home modification meets the conditions of the inspection, the
DSA must send a completed Form 8605, Documentation of Completion of Purchase, to the
individual's CMA within seven business days after completion of the inspection.
If the DSA determines the minor home modification does not meet the conditions of the
inspection, the DSA must ensure the vendor meets the conditions within 30 calendar days after
the DSA's determination.
3600 Habilitation Services Documentation
Revision 11-1; Effective June 13, 2011
If the individual receives habilitation services as part of their service plan, the DSA must
document and maintain the following in the individual record (except for items that are not
relevant):
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the need for specific habilitation tasks;
standing physician's orders for any delegated tasks;
the provider's annual assessment of the person's ability to manage their own habilitation
services;
any training and/or other support provided to the individual to enable the individual to
manage their own habilitation services;
conflicts/problems between the individual and the habilitation staff, and how these
conflicts/problems were resolved; and
annual documentation of the satisfaction with habilitation using Form 3599, Habilitation
Service Provider Orientation/Supervisory Visits.
Tasks performed by attendants must be provided with proper regard for the individual's health,
safety, welfare and personal autonomy.
If any of the following services are provided, the DSA must evaluate and document the
effectiveness at least once per quarter:
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habilitation training services,
prevocational services, or
supported employment services.
The evaluation must include an assessment of the individual's progress, evolving needs and plans
to address identified needs.
The DSA must also inform the case manager of any significant changes in the service plan and
provide the case manager with quarterly summaries of the individual's progress and needs.
The DSA must provide habilitation training services that meet the individual's needs as specified
in the IPC and IPP. The individual or LAR must be afforded an informed choice of settings,
techniques and training objectives. The individual or LAR may request training be modified to
accommodate individual needs.
Training must be provided in community settings; that is, places where the individual lives or
works and in settings similar to these. The training must teach skills the individual can practice
and apply in daily life. The habilitation trainer must provide and document the following in the
individual's record, if relevant:
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evaluations of progress and needs;
times, dates and content of training;
observable and measurable goals and objectives of training;
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evidence of how training is integrated with other services such as residential habilitation
and therapies; and
individual involvement in choosing the training program.
Form Resources
The following forms may need to be completed:
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Form 2067, Case Information
Form 3596, CLASS/DBMD – Habilitation Plan
Form 3597, CLASS – Habilitation Training Plan
Form 3599, Habilitation Service Provider Orientation/Supervisory Visits
Form 3621, CLASS – Individual Plan of Care
Form 3625, Documentation of Services Delivered
Form 8606, Individual Program Plan (IPP)
3700 Money Management/Trust Fund
Revision 11-1; Effective June 13, 2011
The SPT will address the individual's need for money management assistance. If an individual
requires assistance with money management, this can be addressed during completion of Form
3596, CLASS/DBMD – Habilitation Plan.
Individuals receiving CLASS services will be encouraged to practice responsible personal
money management. If the DSA maintains the individual's finances, it must do so in a way that
protects the financial interests of the individual receiving CLASS services.
Individuals receiving CLASS services will be encouraged and allowed to manage their own
finances, whenever possible.
Individuals who are capable of managing their own finances will:
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receive training by the DSA as needed to enable them to do so; and
establish a secure place to store cash.
If the individual does not manage his own funds, the DSA must explain in writing why the
individual is unable to perform the activity and what steps are being taken to increase the
individual's independence. The provider must also maintain the funds in accordance with trust
fund requirements as noted in 40 TAC §19.405, Additional Requirements for Trust Funds in
Medicaid-certified Facilities.
3800 Changes in Individual Status
Revision 11-1; Effective June 13, 2011
The DSA must report changes in an individual's status within 24 hours of awareness of the
change to the case manager on Form 2067, Case Information.
The following are examples of changes in the individual's condition or circumstances that require
notification to the case manager:
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the individual no longer needs services;
the individual is admitted to the hospital;
the individual is discharged from a hospital;
problems exist with family relationships that impact service delivery;
the individual is evicted or otherwise loses their housing that impacts service delivery;
the individual relocates;
the individual has an illness or injury that impacts service delivery; and
the individual loses Medicaid eligibility.