Source: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/texas-home-living-txhml/how-apply-become-a-txhml-provider
Timestamp: 2018-02-25 17:30:15
Document Index: 360397817

Matched Legal Cases: ['art 1', '§49', 'art 1', '§49', '§49', 'art 1', '§49', '§455', '§49']

How to Apply to Become a TxHmL Provider | Texas Health and Human Services
How to Apply to Become a TxHmL Provider
Home > Doing Business with HHS > Provider Portals > Long-term Care Providers > Texas Home Living (TxHml) > How to Apply to Become a TxHmL Provider
Note: An applicant seeking to obtain a contract must enroll in Texas Medicaid. Please visit the Medicaid Provider Enrollment web page to view the enrollment requirements.
The Texas Department of Aging and Disability Services (DADS) accepts applications from applicants through its open enrollment process to contract for the Texas Home Living (TxHmL) Medicaid waiver program. Under the open enrollment process, contracts are awarded on a noncompetitive basis to eligible applicants meeting the qualifications and other requirements established by DADS.
There is no deadline to submit an application packet for the TxHmL program. Applications can be submitted anytime year round.
In accordance with Texas Administrative Code, Title 40, Part 1, Chapter 49, Subchapter B, §49.203(a)(1), TxHmL program provider applicants are required to complete a Pre-Application Orientation (PAO) before submitting an application packet to DADS.
TxHmL program provider applicants are required to:
successfully complete the Pre-Application Orientation (PAO)
properly complete the application packet and include all required documents in accordance with DADS instructions; and
once DADS has preliminarily approved an application packet, applicants will be further required to complete the provider competency examination and the provider application training in accordance with Texas Administrative Code, Title 40, Part 1, Chapter 49, Subchapter B, Rule §49.204 (c).
Applications packets must be sent to:
Mail Code W-359
Note to all applicants: Please do not submit applications within binders or cover sheets. Each application page needs to be date stamped for date of receipt.
DADS requires, in accordance with 40 TAC §49.203(b)(1), application packets to be submitted no later than 60 days following the completion of all PAO requirements.
DADS Form 5873, HCS/TxHmL Waiver Program Application Packet Checklist, includes all required forms and documents of an application packet. Program provider applicants should use this as a guide and final checklist to ensure their application packets are complete.
Applicants should remember to:
Use the application packet checklist (Form 5873) as a guide.
Answer all the questions on each required form.
Have the signature authority — the owner or authorized representative of the legal entity — sign and date each form. (An authorized representative is the person named on DADS Form 2031, Governing Authority Resolution - Business Organization).
Have the applicable forms notarized.
Complete each required form accurately in accordance with DADS instructions.
Not use correction tape or fluid. (If a mistake is made, mark through it with a single line and initial the change.)
Review the completed application packet.
Retain a copy of the completed application packet.
Click here to read the Texas Administrative Code, Title 40, Part 1, Chapter 49, Subchapter B, §49.203 as it relates to the provisional contract application process.
The following forms should be completed in accordance with DADS instructions. Please do not send instructions or blank/unused form pages with an application packet.
Unless indicated otherwise, all of the following forms and documents must be submitted regardless of the type of community service provided.
Copy of National Provider Identifier (NPI) notification letter (Not required for non-healthcare services)
Form 2031, Governing Authority Resolution, Business Organization
Form 3681, Community Services Contract Application
Form 3691-A, Service Area Designation [For Home and Community-based Services (HCS), Texas Home Living (TxHmL), Consumer Directed Services (CDS) and Transition Assistance Services (TAS) in lieu of Form 3691]
Form 4732-A, Nongovernmental Contractor Certification (Part II), if applicable
Form 5871, Disclosure of Ownership and Control Interest Statement
Form 5871-S, Disclosure of Ownership and Control Statement — Short Form
In addition to the forms and documents listed above, the following forms must be completed and submitted:
DADS Form 5873, HCS/TxHmL Waiver Program Application Packet Checklist
DADS Form 5875, HCS Waiver Program Self-Assessment Certification (if applying to become an Home and Community-based Services provider)
DADS Form 5920, TxHmL Waiver Program Self-Assessment Certification (if applying to become a TxHmL provider)
The following documents must be completed and submitted with the application packet in accordance with DADS instructions:
A copy of National Provider Identifier (NPI) verification email or letter.
The program manager's resume.
As indicated in Section 7b of Form 3681, this individual must attend the provider competency examination and receive a score of at least 85 percent.
The resume must reflect:
at least three years paid work experience in planning and providing TxHmL Program services to an individual with an intellectual disability or related condition as verified by written statements from the person's employer; or
have both of the following:
at least three years of experience planning and providing services similar to TxHmL Program services to a person with an intellectual disability or related condition as verified by written statements from organizations or agencies that provided services to the person; and
participation as a member of a microboard as verified, in writing, by:
the certificate of formation of the non-profit corporation under which the microboard operates filed with the Texas Secretary of State;
the bylaws of the non-profit corporation; and
a statement by the board of directors of the non-profit corporation that the person is a member of the microboard.
month and year of employment.
Three letters of reference for the program manager.
Each reference letter must:
be verifiable by address or phone number.
Copies of PAO certificates of completion:
must include copies for each individual who is required to complete the PAO;
must include a copy for all two modules;
must be signed by the individual completing the PAO; and
must have a score of 85 percent or higher for each module.
Copies of receipts for criminal history records requests must be submitted for all required individuals.
Copy of Assumed Name Certificate, if applicable.
Copy of driver’s license or ID card
Certificate of Formation (Secretary of State)
If a foreign entitiy, Certificate of Registration (Secretary of State)
Any Certificates of Amendments (if applicable)
If a foreign entity, Certificate of Registration (Secretary of State)
Copies of driver licenses or ID cards
DADS requires an TxHmL provider program applicant to submit criminal history record information in accordance with 42 Code of the Federal Regulations (CFR) §455.106. To comply with this requirement, DADS must receive criminal history record information from the Texas Department of Public Safety (DPS) for each individual described below.
Program provider applicants must disclose criminal history record information for all individuals with an ownership or control interest. A person with an ownership or control interest means a person or corporation who:
has direct or indirect ownership interest equal to or totaling 5 percent or more in the disclosing entity;
has a combination of direct and indirect ownership interests equal to 5 percent or more in the disclosing entity;
owns an interest of 5 percent or more in any mortgage, deed of trust, note or other obligation secured by the disclosing entity if that interest equals at least 5 percent of the value of the property or assets of the disclosing entity;
is an agent, officer, director or managing employee of an applicant that is organized as a corporation; or
is an agent, officer, director or managing employee of an applicant that is organized as partnership.
An "agent" is defined as an individual who has been delegated the authority to obligate or act on behalf of an applicant.
A "managing employee" or "director" is defined as a general manager, business manager, administrator, director, program manager or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of the disclosing entity.
An "officer" is defined as an individual who is a member of the disclosing entity's board of directors such as the president, secretary, treasurer or board member.
DPS has entered into an exclusive contract with L-1 Enrollment Services to provide statewide electronic fingerprinting for criminal history record requests. Individuals will need to schedule an appointment at a Fingerprint Applicant Services of Texas (FAST) location to complete their criminal history record request. Once fingerprinting has been completed, FAST will electronically send the request to DPS which will in turn send the results to DADS, as requested by the individual.
Please note that there are fees associated with acquiring criminal history records. In addition, DPS will not expedite last minute requests for criminal history record information.
The easiest way to complete this requirement is to schedule an appointment online Fingerprint Applicant Services of Texas (FAST). Appointments can also be scheduled by phone at 1-888-467-2080. A list of all FAST locations in Texas and their hours can be found online. The cost of this service is $10 plus a $15 fee for the criminal history.
Instructions to schedule an appointment online
Please note that when scheduling your appointment, you will be asked where the results of your criminal history record request should be sent. DADS requests that all criminal history record requests be sent to:
ATTN: Sarah Schmidt
DADS may require an applicant to provide additional information regarding the certification of criminal history information. Furthermore, DADS may deny a contract application packet based on:
the results of the criminal history record information submitted; and
an applicant's failure to comply with the requirements.
Note: DADS, at its discretion, may deny an application if the applicant or any person with an ownership or control interest in the applicant, or an agent or managing employee of the applicant has been convicted of any criminal offense listed in the Texas Administrative Code §49.206.
How Out-of-State Applicants Submit Criminal History Records
An out-of-state owner must obtain a criminal history record from DPS instructions.
Go to http://www.dps.texas.gov/
Click on "Crime Records" on right side of webpage
Click on "Review of Personal Crime History (PDF)"
Scroll down to "Alternate Option: Fingerprint Cards Submitted by Mail"
Choose to pre-enroll your hard fingerprint card submission either on-line or by telephone.
You will be required to provide the Designated Recipient of your criminal history check. All requests should be sent to DADS, not to the person being fingerprinted. Provide the following information:
Designated Recipient Name: DADS ATTN: Sarah Schmidt Mail Code W-359
Do not check "Use My Address" if pre-enrolling on-line
Address Line 1: P.O. Box 149030
Postal Code: 78714-9030
If you are asked to provide an "ORI," please respond "txireview."
Complete Steps 2 and 3. Scroll down to view and print Personal Review Service Code Form.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that each health care entity use an assigned National Provider Identifiers on standard health care transactions. Therefore, as of Dec. 1, 2006, DADS has required all health care entities applying to contract with DADS to obtain and report their NPI in order to comply with this HIPAA requirement.
An applicant must submit an NPI assignment letter or an email from the National Plan and Provider Enumeration System (NPPES), to DADS verifying the NPI that corresponds with the legal entity of the applicant. The NPPES verification must be submitted to DADS along with the application packet.
The NPI is a nationally recognized ten digit number that is used to identify healthcare providers when conducting standard transactions with multiple health plans. The National Plan and Provider Enumeration System (NPPES) issues NPI(s) at the direction of the Centers for Medicare and Medicaid Services (CMS). HIPAA requires all healthcare providers to apply for an NPI. A healthcare provider is someone who provides health care services. An example of health care services includes professional therapies, nursing services, dental or physician services. NPI(s) are not automatically assigned; there is an application process.
The NPI Application Process
The online application and instructions are available at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.
The application is available for download at: http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.
Taxonomy codes are available online at http://www.wpc-edi.com/codes/taxonomy. The taxonomy codes for the majority of DADS providers are found in the Non-individual section of the Health Care Provider Taxonomy guide. Select the taxonomy that best describes your business.
For application help please visit: https://nppes.cms.hhs.gov/NPPES/Help.do?topic=CntInfAndAnnouncement.