Source: https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/intermediate-care-facilities-individuals-intellectual-disability-or-related-conditions-icfiid/how-become-icfiid-provider
Timestamp: 2018-07-22 03:24:57
Document Index: 256057862

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How to Become an ICF/IID Provider | Texas Health and Human Services
Home > Doing Business with HHS > Provider Portals > Long-term Care Providers > Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) > How to Become an ICF/IID Provider
There is no additional funding for new intermediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) and there has not been for several years.
If funding should become available, notice will be posted in the Texas Register.
Contract Assignment/Change of Ownership (CHOW)
In accordance with the Texas Administrative Code, Title 40, Part 1, §9.217, a program provider must notify the ICF/IID Licensure and Certification (L&C) unit in writing at least 30 days before the date of a proposed assignment/CHOW. In addition, a provider must submit a license change of ownership application 30 days prior to the effective date.
The legal name and federal tax identification number of the proposed assignee
The proposed date of the assignment, which must be on the first day of a month
The provider vendor number of the assignor
An application for enrollment obtained from the ICF/IID L&C unit and completed by the assignee as required for provider applicants
A copy of the assignment agreement, which must include a statement that the assignee:
must keep, perform and fulfill all of the terms, conditions and obligations that must be preformed by the assignor under the provider agreement;
is subject to all pending conditions that exist against the assignor including, but not limited to, any plan of correction, audit exception, vendor hold or proposed contract termination; and
is liable to HHS for any liabilities or obligations that arise from any act, event or condition that occurred or existed before the effective date of the assignment and that is identified in any survey, review or audit conducted by HHS.
ICF/IID Licensure and Certification Unit
Mail Code E330
Upon receipt of notice the ICF/IID L&C unit will:
Impose a vendor hold on payments due to the assignor under the provider agreement until the following audit and review are completed and any amounts owed to HHS are resolved:
an audit is conducted in accordance with the Texas Administrative Code, Title 40, Part 1, §9.269, and
a review of the fiscal accountability cost report is conducted in accordance with 1 TAC §355.452 and 1 TAC §355.457.
Review the application for enrollment.
Provide written notice to the assignor stating whether the application is approved or rejected.
The ICF/IID L&C unit may reject an application for enrollment as set forth in the Texas Administrative Code, Title 40, Part 1, 9.206(e). If the application is rejected, the assignor may withdraw the proposed assignment. If the assignment is not withdrawn, the department may terminate the assigned provider agreement.
If the ICF/IID L&C unit approves the proposed assignee—s application for enrollment, they will notify HHS Regulatory Services Regional Office of the assignment and request that Regulatory Services Regional Office initiate licensure and certification action.
License Change of Ownership
Program providers must submit a completed licensure change of ownership application 30 days before the effective date. HHS may conduct a health inspection. If the facility is found to meet licensure requirements, a license will be issued. Please submit the following forms:
Form 3604 Ownership Transfer Affidavit
Form 3604-A Ownership Transfer Affidavit Addendum for ICF/IID
Form 3720 Application for State License to Operate a Long Term Care Facility
Required Entity Documents (See below)
Property Documents (Deeds, Leases, Subleases, etc.)
Mail your licensure application, documents and required fees to:
Mail Code E- 411
Mail Code E — 411
The assignor must, before the effective date of the assignment, give written notice to each individual residing in the facility or his or her LAR of the proposed assignment and the proposed effective date of the assignment.
If the facility is licensed in accordance with state law and determined by the state survey agency to meet certification requirements on or before the 90th day after the effective date of the assignment, HHS will pay the assignee for services provided on and after the effective date of the assignment. The agency will not pay the assignee for any period of time during the 90-day period that the facility was determined by HHS Regulatory Services not to meet certification requirements.
If the facility is not licensed in accordance with state law and determined by the state survey agency to meet certification requirements on or before the 90th day after the effective date of the assignment, the agency will terminate the provider agreement effective on the 91st day. A survey completed more than 90 days after the effective date of the assignment will not be used to determine if the facility met the licensure and certification requirements within the 90-day period.
If the facility is licensed in accordance with state law and determined by HHS Regulatory Services to meet certification requirements, the ICF/IID L&C unit will initiate an ICF/IID Provider Agreement. The program provider must execute and submit the agreement to the ICF/IID L&C unit in accordance with the Texas Administrative Code, Title 40, Part 1, §9.215(g).
During the 90-day period after the effective date of the assignment, the provider agreement is subject to sanctions, including termination, in accordance with Chapter 9, Subchapter E, Division 7 relating to Provider Agreement Sanctions.
Upon the effective date of the assignment, the assignee:
Must keep, perform and fulfill all of the terms, conditions and obligations that must be performed by the assignor under the provider agreement.
Is subject to all pending conditions which exist against the assignor, including but not limited to, any plan of correction, audit exception, vendor hold or proposed contract termination.
Is liable to HHS for any liabilities or obligations that arise from any act, event or condition that occurred or existed before the effective date of the assignment and that is identified in any survey, review or audit conducted by HHS Regulatory Services.
Facility Relocation Requirements
In accordance with the Texas Administrative Code (TAC), Title 40, Part 1, §9.215(a), before relocating a facility, a program provider must receive approval from the Texas Health and Human Services (HHS) Regulatory Services, ICF/IID Licensure and Certification (L&C) unit. In addition, a provider must submit a license relocation application 30 days prior to the move to HHS Regulatory Services, ICF/IID L&C unit, and the new location must pass a HHS Life Safety Code inspection.
Contract Relocation Application
Before the facility relocation, a program provider must complete and submit to HHS ICF/IID L&C unit a facility contract relocation application, in accordance with the TAC, Title 40, Part 1, §9.215(b).
To request an ICF/IID Contract Relocation Application, submit your request to:
The contract relocation application must contain the following documentation:
Form 3600, Application For Participation As A Title XIX ICF/IID Facility
Proof that the provider has a property interest in the new location (earnest money, contract, deed of trust, mortgage agreement, lease, etc.)
Map indicating new location
The application must also contain the following narrative information:
Number of Medicaid-certified beds
Proposed new facility name (if applicable)
In addition to the application, the provider must ensure and state in the narrative that the:
Relocation does not remove residents from services that are currently available.
Proposed facility must be equal to or exceed the quality of the current facility.
Relocation complies with program admission and contract provisions that were in effect at the time of the first approval for participation.
Facility will comply with the provisions of the Texas Administrative Code, Title 40, Part 1, 27.707 (release from the facility) if the residents choose not to relocate.
HHS will provide written notice to the program provider of its approval or denial. An incomplete application will not be approved in accordance with the TAC, Title 40, Part 1, §9.215(c).
If the ICF/IID L&C unit approves the contract application for facility relocation, they will notify HHS Regulatory Services Regional Office of the facility relocation and request that Regulatory Services Regional Office initiate licensure and certification action of the relocated facility in accordance with the Texas Administrative Code, Title 40, Part 1, §9.215(d).
License Relocation Application
Program providers must also submit a completed licensure application 30 days before the move. HHS must conduct a Life Safety Code inspection of the new building before residents can be moved in.
The license relocation application must contain the following documentation:
Required Entity Documents (See list of documents below)
Letter to HHS indicating official move-in date
Submit the 3720 application and supporting documents to:
Mail Code E411
In accordance with the TAC, Title 40, Part 1, §9.215(e) before the relocation, the program provider must notify each individual residing in the facility and his or her legally authorized representative (LAR) in writing of the date of facility relocation and the address of the relocated facility or explain to the individual or LAR why shorter notification was necessary.
At the time of relocation, the program provider must notify in writing the local authority in whose local service area the facility has relocated of the name and address of the relocated facility in accordance with the TAC, Title 40, Part 1, §9.215(f).
If the relocated facility is licensed in accordance with state law and determined by DADS Regulatory Services to meet certification requirements, the ICF/L&C unit will initiate an amendment to the provider agreement to reflect the address of the relocated facility. The program provider must execute and submit the amendment to the ICF/L&C unit in accordance with the TAC, Title 40, Part 1, §9.215(g).
The Texas Department of Health and Human Services (HHS) will mail the preprinted renewal application and instructions to the owner 120 days before the license expires. You must submit your renewal application at least 45 days before the license expiration date. A license holder who submits an application for renewal during the 45-day period ending on the date the current license expires must pay a late renewal fee in an amount equal to one-half of the renewal fee.
Mail your license renewal application, documents and required fees to:
The Texas Department of Health and Humany Services (HHS) surveys intemediate care facilities for individuals with an intellectual disability or related conditions (ICF/IID) annually to ensure that they are in compliance with federal certification and state licensure regulations. HHS also investigates self-reported incidents from facilities and complaints from individuals, family members, friends and others. Surveyors initiate investigation of complaints and incidents in facilities within 24 hours, 14 days or 45 days, depending on the priority assigned by the intake program specialist who receives the complaint or incident report. The priority is based on the immediacy and seriousness of the allegation.
HHS conducts on-site investigations for all complaints received. If HHS determines that the facility has investigated a self-reported incident, has determined the cause and has made the necessary changes to remove the problem, HHS may elect not to conduct an on-site investigation. If surveyors find a federal deficiency or state licensure violation during a visit, survey staff will make a follow-up visit to ensure that the facility has corrected the deficiency or violation and is in compliance with the regulations. HHS does not notify facilities before conducting surveys or investigations. For information on how to report a complaint, please visit the HHS Consumer Rights and Services website.
HHS has available surveyors from a number of professional disciplines, including qualified intellectual disability professionals, registered nurses, social workers, nutritionists, pharmacists, architects, engineers and Life Safety Code specialists. A team of specialists conducts the annual facility survey. HHS assigns one or more surveyors from specific areas of expertise to investigate complaints and incidents based on the nature of the complaint or incident and facility size.
When the survey team completes the survey, inspection, investigation, follow-up or other visit, it writes a report of the findings that details the facility's failures to comply with federal or state regulations, which are called deficiencies and violations, respectively. The facility must make survey reports available to all facility clients and visitors. Interested parties may also request survey team visit results from Consumer Rights and Services at 1-800-458-9858.
In accordance with Section II.C. of the ICF/IID Agreement, providers are required to notify the Texas Department of Health and Human Services (HHS) Institutional Services (IS) Contracts section in writing of any changes to the information contained in their contract application at least 10 days before making such changes. Providers must also send notice of updates to HHS Regulatory Services, Licensing and Credentialing section.
Note: This section only applies to the legal entity physical, legal entity mailing, and facility mailing address, phone and facsimile numbers, doing business as (DBA) name changes, entity name changes and contact person information. For information on relocating a facility, see the "Facility Relocation Requirements" section of this website. For information on changes of ownership, see the "Contract Assignment/Change of Ownership (CHOW) Requirements" section of this website.
Notice of Contract Information Update
Current facsimile
The request will not be processed unless the individual listed on the Board of Directors Resolution or its equivalent has signed the request.
Requests should be submitted to the address below:
Mail Code W535
Please contact IS Contracts at 512-438-3554, if you have any questions.
Notice of License Information Update
Program providers must also submit updated information to DADS Regulatory Services, Licensing and Credentialing section. Updates include changes to: telephone numbers, mailing addresses, doing business as (DBA) name changes, entity name changes and contact person information. (Example: A change of the real property owner's address is an update, but a change of the real property owner is a real estate change. A change of a controlling person with no ownership interest is an update, but a change of a controlling person with ownership interest is either a stock transfer or change of ownership, depending on the percentage of ownership interest.)
On Form 3720 Application for State License to Operate a Long Term Care Facility, provide the type of update. Enter an explanation of the information being updated and the corresponding item number. (Example: Controlling Persons, Item 7).
On Form 3720 Application for State License to Operate a Long Term Care Facility, provide the effective date of the update. During the application review process, HHS may change the effective date requested by the applicant to reflect the effective date approved by HHS.
For a business or governmental entity name change, send one copy of the Articles of Amendment filed by the Office of the Texas Secretary of State together with a copy of the certificate evidencing its filing, or other legal documentation of the name change.
For a DBA name change, send a copy of the Assumed Name Certificate from the Secretary of State for business entities or county clerk's office for government entities.
Submit updates to: