On June 29, 2017 Texas Health and Human Services released Information Letter No. 17-15 (IL 17-15), Removal of Service Codes for Habilitation and Residential Habilitation,
This letter applies to providers who are contracted to provide the services in the following programs.
- Community Living Assistance and Support Services (CLASS)
- Case Management Agencies (CMAs)
- CLASS Direct Services Agencies (DSAs)
- Deaf Blind Multiple Disabilities (DBMD) Program Providers
- Financial Management Services Agencies (FMSAs)
IL 17-15 states that effective July 10, 2017, to prevent billing submissions for unavailable service codes the following service codes will be removed by HHS,
- service codes 10, 10A, and 10V associated with CLASS habilitation; and
- service codes 17 and 17V associated with DBMD residential habilitation.
Once these service codes are removed, a CLASS DSA, DBMD program provider, or FMSA will not be able to submit a service claim that includes any of these service codes.
For questions about this letter or the implementation of the changes below, please contact the CLASS program at classpolicy@hhsc.state.tx.us or the DBMD program at dbmdpolicy@hhsc.state.tx.us.
As described in Texas Administrative Code (TAC), Title 40, §45.104(e) and §42.104(e), a CLASS DSA or DBMD program provider may only provide and bill for habilitation or residential habilitation if the activity provided is transportation. The correct service codes to use for transportation as habilitation or residential habilitation are set forth in Information Letter (IL) 2015-53, Providing Transportation in the Community Living Assistance and Support Services and Deaf Blind with Multiple Disabilities Waiver Programs.
To bill for Community First Choice personal assistance services/habilitation (CFC PAS/HAB) that an individual receives from a CLASS DSA or DBMD program provider, the DSA or DBMD program provider must use service code 10 CFC. To bill for CFC PAS/HAB an individual receives through the consumer directed services option, an FMSA must use service code 10 CFV.
CLASS CMAs, CLASS DSAs, DBMD program providers, and FMSAs must ensure that any individual plan of care (IPC) currently containing service code 10, 10A, 10V, 17, or 17V is revised, in accordance with 40 TAC §45.223 or §42.223, to remove the code and replace it with the correct service code.
CLASS FORM CHANGES
These forms have been revised to remove service code 10, Habilitation, service code 10 A, Habilitation – Delegated and 10V, Habilitation.
DBMD FORM CHANGES
These forms have been revised to remove service code 17, Residential Habilitation and service code 17V, Residential Habilitation.
CLASS CMAs, CLASS DSAs, and DBMD program providers must use the applicable, revised IPC form for any IPC, including one concerning a transfer, with an effective date of November 1, 2017 or later. The revised forms will be available on HHSC’s website beginning on July 10, 2017.