These videos give an overview of the various Home and Community-Based Services (HCBS) available in Texas for providers who want to learn how to start or operate an HCBS agency in the state. Each video explains the purpose of the service, provider requirements, licensing process, and how the program functions. Use these videos to better understand the responsibilities, standards, and steps involved in becoming or working with approved HCBS providers in Texas. Explore each section to find the service that best matches your goals or area of interest.
Respite Care
RESPITE CARE SERVICES PROVIDER IN TEXAS
PROVIDING TEMPORARY RELIEF TO FAMILY CAREGIVERS WHILE SUPPORTING THE HEALTH AND SAFETY OF INDIVIDUALS WITH DISABILITIES IN HOME AND COMMUNITY SETTINGS
Respite Care Services in Texas offer short-term, planned or emergency relief for primary caregivers of individuals with disabilities, chronic illnesses, or complex care needs. These services are reimbursable under various 1915(c) Medicaid Waiver programs such as HCS, CLASS, TxHmL, DBMD, and MDCP, and are overseen by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers waiver programs, approves providers, and oversees reimbursement for respite care services.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures state waiver programs meet federal Medicaid HCBS requirements, including caregiver support.
2. RESPITE CARE SERVICES OVERVIEW
Respite care provides temporary relief for unpaid caregivers while ensuring the participant continues to receive safe and appropriate care. It can be delivered in the participant's home, a provider’s facility, or community-based settings, based on the Individual Plan of Care (IPC) or Person-Directed Plan (PDP).
Service formats may include:
In-home respite: Supervision and support provided at the participant’s residence
Out-of-home respite: Provided in licensed foster homes, group homes, or day programs
Emergency respite: For crises when caregivers are unavailable
Planned respite: Scheduled breaks for families based on need or risk of burnout
All services must prioritize health, safety, and community inclusion while the primary caregiver is away.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a Medicaid provider via TMHP (Texas Medicaid & Healthcare Partnership)
Apply for waiver-specific contract approval with HHSC (e.g., HCS, CLASS, MDCP)
If offering out-of-home respite, obtain applicable residential licensure through HHSC
Maintain general liability and professional insurance
Develop a Respite Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form business entity and secure EIN/NPI
Step 2: Enroll with TMHP as a Medicaid provider
Step 3: Submit a waiver contract application to HHSC (indicating respite as a service offering)
Step 4: Provide staff credentialing, documentation tools, and policy manual
Step 5: Complete readiness review and begin receiving authorizations from case managers
5. REQUIRED DOCUMENTATION
EIN, NPI, Articles of Incorporation
TMHP enrollment and HHSC waiver contract
Insurance certificates and staff background checks
Respite Services Policy Manual including:
Staff supervision and training policies
Incident prevention and reporting protocols
Daily service documentation templates
Emergency contact, evacuation, and health procedures
Participant rights, grievance, and abuse prevention procedures
Service authorization tracking and billing forms
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP) / Respite Caregiver
Requirements: High school diploma/GED, CPR/First Aid, abuse prevention training, background check
Role: Program Supervisor (optional for in-home, required for out-of-home settings)
Requirements: Experience managing waiver services and staff coordination
All staff must complete:
HHSC-required HCBS waiver training
Individual-specific health and safety training
Emergency and crisis response readiness
Daily documentation and service verification procedures
Confidentiality and HIPAA training
7. MEDICAID WAIVER PROGRAMS
Respite Care is available under:
HCS (Home and Community-Based Services)
CLASS (Community Living Assistance & Support Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities Program)
MDCP (Medically Dependent Children Program)
YES Waiver – For children with serious emotional disturbances
STAR+PLUS – Limited in-home respite for certain eligible adults
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Application
Timeline: 2–3 months
Phase: Staff Hiring & Training
Timeline: 30–60 days
Phase: Contract Execution & Referral Activation
Timeline: Begins after HHSC readiness review and service authorization
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX RESPITE CARE PROVIDER
WCG assists caregivers, community programs, and provider agencies in launching Medicaid-approved respite care services across Texas.
Scope of Work:
TMHP and HHSC waiver enrollment guidance
Custom Respite Services Policy & Procedure Manual
Staff orientation checklists and supervision logs
Daily care logs, emergency plan templates, and safety forms
Billing tools, authorization tracking sheets, and client rights documentation
Optional: facility licensure support for out-of-home settings
Residential Care
RESIDENTIAL CARE SERVICES PROVIDER IN TEXAS
PROVIDING ROUND-THE-CLOCK SUPPORT IN LICENSED HOMES TO PROMOTE SAFETY, STABILITY, AND INDEPENDENT LIVING FOR INDIVIDUALS WITH DISABILITIES
Residential Care Services in Texas offer 24/7 support and supervision for individuals with intellectual or developmental disabilities (IDD), behavioral health needs, or other long-term conditions that prevent them from living independently. These services are primarily authorized under 1915(c) HCBS Waiver Programs, such as HCS (Home and Community-based Services), TxHmL (Texas Home Living), and DBMD (Deaf Blind with Multiple Disabilities). Oversight is provided by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Authorizes, monitors, and reimburses residential services for Medicaid waiver participants.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures federal compliance with Medicaid HCBS regulations, including person-centered planning and community integration.
2. RESIDENTIAL CARE SERVICES OVERVIEW
Residential services are provided in licensed group homes or supervised living environments. The setting must support the individual's goals for independence, safety, and inclusion.
Service types may include:
24/7 Supervision: Awake staff available day and night
Personal Assistance: Support with bathing, dressing, eating, and mobility
Medication Assistance and Health Monitoring
Household Management: Cooking, cleaning, laundry, grocery shopping
Skill Development: Learning routines, personal hygiene, and independent decision-making
Behavioral Support: If included in the person’s service plan
Transportation to medical or community appointments
Settings can range from 3- or 4-person licensed homes to host homes or companion care arrangements, depending on the waiver program.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Apply for a Residential Services contract under HCS or DBMD via HHSC
Obtain residential site approval from HHSC
Maintain liability insurance, workers’ comp, and home insurance
Create a Residential Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register business and obtain EIN/NPI
Step 2: Enroll with TMHP as a Medicaid waiver provider
Step 3: Apply for HHSC HCS or DBMD provider contract with residential intent
Step 4: Submit floor plan, fire safety documentation, staffing plan, and emergency procedures for homes
Step 5: Undergo HHSC site inspection and readiness review
Step 6: Begin receiving participant referrals after approval
5. REQUIRED DOCUMENTATION
EIN, NPI, business formation documents
TMHP and HHSC provider approvals
Residential site approval and safety plan
Liability, property, and workers’ comp insurance
Residential Services Policy Manual including:
Participant admission and orientation process
Shift scheduling and awake staff logs
Medication assistance, behavior support, and health monitoring procedures
Emergency preparedness and fire drill logs
Participant rights, privacy, and community inclusion plans
Staff training, incident tracking, and QA systems
Billing logs, daily service notes, and progress summaries
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP)
Requirements: Age 18+, background check, CPR/First Aid, waiver training
Role: Residential Manager / House Supervisor
Requirements: Experience with IDD population, supervisory skills, staffing oversight
Role: RN (if providing medication assistance or delegated nursing tasks)
Requirements: Texas nursing license and waiver-compliant training
All staff must complete:
HHSC-compliant waiver training
Abuse, neglect, and exploitation prevention
HIPAA, documentation, and rights education
Behavior intervention (if needed) and incident reporting
Fire safety and emergency response
7. MEDICAID WAIVER PROGRAMS
Residential Care is a core service under:
HCS (Home and Community-based Services) – Group homes and Host Homes
DBMD (Deaf Blind with Multiple Disabilities) – Licensed settings or companion homes
TxHmL (Texas Home Living) – Limited residential support in some cases
YES Waiver – For youth in intensive foster or community-based settings (non-licensed homes)
8. TIMELINE TO LAUNCH
Phase: Business Formation & Site Preparation
Timeline: 2–3 months
Phase: TMHP & HHSC Waiver Contracting
Timeline: 2–4 months
Phase: Staffing, Licensure Prep, and Readiness Review
Timeline: 1–2 months
Phase: Launch Services Post-Approval
Timeline: Following site approval and participant authorization
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX RESIDENTIAL SERVICES PROVIDER
WCG helps agencies and entrepreneurs navigate the launch of licensed group homes, companion care, and host home services under Texas HCBS programs.
Scope of Work:
TMHP and HHSC waiver enrollment
Residential Policy & Procedure Manual
Fire drill logs, staffing patterns, and emergency plans
Participant intake and house rules templates
Medication logs, supervision schedules, and shift documentation
Readiness review preparation and licensing coaching
Supported Employment
SUPPORTED EMPLOYMENT SERVICES PROVIDER IN TEXAS
EMPOWERING INDIVIDUALS WITH DISABILITIES TO ACHIEVE COMPETITIVE, INTEGRATED EMPLOYMENT THROUGH PERSON-CENTERED SUPPORTS
Supported Employment Services in Texas help individuals with intellectual and developmental disabilities (IDD), behavioral health challenges, or physical disabilities obtain and maintain meaningful work in the community. These services are covered under 1915(c) Medicaid Waiver Programs such as HCS, CLASS, TxHmL, DBMD, and also supported through the Texas Workforce Commission (TWC) for employment-first efforts. The Texas Health and Human Services Commission (HHSC) oversees service authorization and compliance for waiver-based providers.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers Medicaid waiver employment services, issues provider approvals, and monitors service delivery.
Agency: Texas Workforce Commission (TWC)**
Role: Coordinates vocational rehabilitation services that often complement waiver-funded employment supports.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures compliance with HCBS waiver employment guidelines under federal Medicaid law.
2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW
Supported Employment helps individuals prepare for, obtain, and retain competitive jobs that pay at least minimum wage and are located in integrated community settings.
There are two primary components:
Job Development:
Employment goal-setting
Resume and application support
Job search coaching
Interview preparation and advocacy
Employer engagement and accommodation consultation
Job Coaching / Ongoing Supports:
On-site support and skill-building
Task analysis and prompts for job duties
Transportation training or support
Workplace social interaction coaching
Long-term follow-up to ensure job success and retention
All services must be linked to goals in the Person-Directed Plan (PDP) or Individual Plan of Care (IPC).
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Apply for HHSC waiver contracts (e.g., HCS, CLASS, TxHmL)
Maintain general liability insurance and worker’s comp
Partner with or be familiar with TWC vocational rehabilitation resources
Develop a Supported Employment Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register your agency and obtain EIN/NPI
Step 2: Enroll with TMHP as a waiver provider
Step 3: Apply for HHSC waiver contracts with Supported Employment as a listed service
Step 4: Submit staff qualifications, service flow procedures, and job coaching plan samples
Step 5: Complete readiness review and begin receiving participant authorizations
5. REQUIRED DOCUMENTATION
EIN, NPI, and business formation documents
TMHP enrollment and HHSC waiver approval letters
Insurance certificates
Supported Employment Policy Manual including:
Employment assessment and goal planning procedures
Documentation for job development and coaching hours
Contact logs with employers and support coordinators
Participant rights, workplace safety, and ADA considerations
Incident reporting and quality assurance processes
Billing logs and service verification templates
HIPAA and employment confidentiality standards
6. STAFFING REQUIREMENTS
Role: Employment Specialist / Job Coach
Requirements: High school diploma or equivalent, relevant experience preferred, background check, CPR/First Aid
Role: Program Supervisor (optional)
Requirements: Knowledge of job development, behavioral supports, documentation standards
All staff must complete:
Person-centered planning and employment-first training
Employer engagement, ADA, and disability accommodation training
Incident response, safety, and abuse prevention
Medicaid service documentation and confidentiality compliance
7. MEDICAID WAIVER PROGRAMS
Supported Employment is an approved service under:
HCS (Home and Community-based Services)
CLASS (Community Living Assistance & Support Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
YES Waiver – Through wraparound and transition-to-adulthood planning
Supported Employment may also be coordinated with TWC VR services for job placement support.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Creation
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Contracting
Timeline: 2–3 months
Phase: Staff Onboarding & Readiness Prep
Timeline: 30–45 days
Phase: Begin Service Delivery
Timeline: Upon participant authorization and PDP alignment
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Texas Workforce Commission (TWC) – Vocational Rehabilitation
Website: https://www.twc.texas.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX SUPPORTED EMPLOYMENT PROVIDER
WCG partners with providers and community-based agencies to launch Supported Employment programs that align with Texas waiver goals.
Scope of Work:
TMHP and HHSC enrollment support
Supported Employment Policy & Procedure Manual
Job coaching log templates and employer contact sheets
Goal planning forms and PDP alignment trackers
Staff onboarding and Medicaid billing tools
ADA and workplace accommodation training resources
Home Care
HOME CARE SERVICES PROVIDER IN TEXAS
DELIVERING NON-SKILLED PERSONAL ASSISTANCE AND COMPANIONSHIP TO SUPPORT DAILY LIVING IN HOME AND COMMUNITY SETTINGS
Home Care Services in Texas offer non-medical, personal assistance to Medicaid participants who need help with activities of daily living (ADLs) to remain safely in their homes. These services are distinct from home health (which involves skilled nursing or therapies) and are authorized under various Medicaid programs including STAR+PLUS, MDCP, and State Plan Personal Care Services (PCS). The Texas Health and Human Services Commission (HHSC) regulates provider enrollment and oversight.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers Medicaid and waiver programs, authorizes home care services, and oversees compliance.
Agency: Texas Department of State Health Services (DSHS)**
Role: Licenses Home and Community Support Services Agencies (HCSSAs) to deliver non-skilled personal assistance services.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Regulates Medicaid standards and ensures compliance with federal home care delivery rules.
2. HOME CARE SERVICES OVERVIEW
Home care services support individuals with functional impairments, offering hands-on assistance and supervision tailored to the participant’s daily routines and personal needs.
Common services include:
Bathing, grooming, and dressing
Mobility assistance and transfers
Meal preparation and feeding support
Toileting and incontinence care
Light housekeeping and laundry
Accompaniment to appointments or errands (non-medical transport may be separate)
Monitoring for safety and companionship
These services are authorized based on a physician’s order or waiver service plan and must be documented daily.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for an HCSSA license from the Texas DSHS with “Licensed Home Care Services” as the license category
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Contract with HHSC for waiver-based programs (STAR+PLUS, MDCP, etc.)
Maintain general liability and workers’ compensation insurance
Develop a Home Care Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and obtain EIN/NPI
Step 2: Apply for HCSSA licensure through DSHS (includes application, fees, survey)
Step 3: Enroll with TMHP as a Medicaid provider
Step 4: Apply for waiver contracts with HHSC (if serving MDCP, STAR+PLUS, etc.)
Step 5: Undergo readiness review and receive referrals post-approval
5. REQUIRED DOCUMENTATION
Business formation documents (Articles, EIN, NPI)
HCSSA license from DSHS
TMHP enrollment and HHSC approval letters
Insurance coverage documentation
Home Care Services Policy Manual including:
Participant intake and assessment process
Staff supervision and scheduling
Daily service notes and timekeeping tools
Incident reporting, abuse prevention, and emergency protocols
Participant rights and HIPAA protections
Billing templates and authorization tracking forms
6. STAFFING REQUIREMENTS
Role: Personal Care Attendant / Direct Care Worker
Requirements: Age 18+, background check, CPR/First Aid, orientation training (no license required for non-skilled care)
Role: Supervisor / Home Care Manager
Requirements: Experience in personal care, documentation, and staff oversight
Optional Role: RN Supervisor (for agencies providing both home care and skilled services)
Requirements: Texas RN license and HCSSA supervisory qualifications
All staff must complete:
Orientation on ADLs, personal hygiene, and safety
Participant-specific training
Abuse, neglect, and exploitation prevention
Documentation and daily note writing
HIPAA and confidentiality practices
7. MEDICAID PROGRAMS
Home Care Services are covered under:
STAR+PLUS HCBS Waiver – For elderly and disabled adults
MDCP (Medically Dependent Children Program)
State Plan PCS (Personal Care Services) – For children and youth under 21
Community First Choice (CFC) – Attendant care for individuals with functional needs
8. TIMELINE TO LAUNCH
Phase: Business Registration & Licensure Preparation
Timeline: 2–4 months (HCSSA licensure can be time-consuming)
Phase: Medicaid Enrollment & Waiver Contracts
Timeline: 2–3 months
Phase: Staff Hiring, Orientation & System Setup
Timeline: 30–45 days
Phase: Begin Services Post-Authorization
Timeline: Once referrals and authorizations are received
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Department of State Health Services (DSHS) – HCSSA Licensure
Website: https://www.dshs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX HOME CARE PROVIDER
WCG supports personal care agencies, attendant service startups, and hybrid home care providers in launching compliant services across Texas.
Scope of Work:
HCSSA license application and survey preparation
TMHP and HHSC waiver enrollment support
Home Care Policy & Procedure Manual
Daily shift notes, time sheets, and supervision logs
Abuse prevention training materials and participant intake forms
Medicaid billing templates and compliance audits
Adaptive Equipment
ADAPTIVE EQUIPMENT SERVICES PROVIDER IN TEXAS
ENABLING INDEPENDENCE AND FUNCTIONAL LIVING THROUGH CUSTOMIZED MEDICAL AND NON-MEDICAL EQUIPMENT FOR TEXANS WITH DISABILITIES
Adaptive Equipment Services in Texas provide Medicaid-funded devices and technology to assist individuals with disabilities in performing daily activities and achieving greater independence. These services are delivered through Texas Health and Human Services Commission (HHSC) programs, primarily under 1915(c) Home and Community-Based Services (HCBS) Waivers, such as CLASS, DBMD, HCS, and TxHmL.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers Medicaid waiver programs, sets adaptive equipment service standards, approves providers, and processes reimbursements.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures state Medicaid waiver programs, including equipment coverage, meet federal HCBS requirements.
2. ADAPTIVE EQUIPMENT SERVICES OVERVIEW
Adaptive Equipment Services provide customized or specialized devices used to increase, maintain, or improve an individual’s functional capabilities and safety within the home and community.
Covered items may include:
Wheelchairs (manual, power) and seating systems
Communication devices (speech-generating devices, augmentative tools)
Transfer devices (slings, lifts, gait belts)
Positioning supports (standers, wedges, special mattresses)
Adaptive utensils, bathing tools, or household aids
Environmental controls (switches, remote controls, voice-activated tech)
Specialized computer hardware/software for education, employment, or communication
All items must be medically necessary and approved within the participant’s Individual Plan of Care (IPC) or Person-Directed Plan (PDP).
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain a Tax ID (EIN) and Type 2 NPI
Enroll as a Medicaid provider through TMHP (Texas Medicaid & Healthcare Partnership)
Apply for contract approval under specific waivers via HHSC (e.g., HCS, CLASS, DBMD)
Ensure capacity to assess, recommend, procure, and deliver adaptive equipment
Maintain liability insurance
Develop an Adaptive Equipment Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register entity and secure EIN and NPI
Step 2: Complete TMHP Medicaid enrollment (Provider Enrollment on the Portal - PEP)
Step 3: Apply with HHSC for specific waiver contracts (CLASS, HCS, DBMD, etc.)
Step 4: Submit equipment delivery and documentation procedures
Step 5: Undergo readiness review and begin receiving service authorizations from case managers or service coordinators
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI confirmation
Proof of Medicaid enrollment (TMHP approval)
Liability insurance and vendor warranties
Adaptive Equipment Services Policy Manual including:
Referral and service request procedures
Evaluation and recommendation process (with clinical oversight, if needed)
Equipment procurement, installation, and training process
Documentation of delivery, usage training, and satisfaction
Maintenance, repair, and replacement policies
HIPAA compliance and inventory control
Billing logs and authorization tracking templates
6. STAFFING REQUIREMENTS
Role: Adaptive Equipment Coordinator / Vendor Liaison
Requirements: Experience with DME, assistive tech, or rehab equipment; understanding of waiver compliance
Role: Occupational or Physical Therapist (if required for assessments)
Requirements: Texas licensure; documents medical necessity for specific equipment
Role: Equipment Installer / Technician (optional)
Requirements: Training in device setup, safety, and user support
All staff must complete:
HCBS training and waiver documentation practices
HIPAA, abuse prevention, and safety protocols
Client instruction and usage verification training
Maintenance and troubleshooting awareness
7. MEDICAID WAIVER PROGRAMS
Adaptive Equipment Services are available through:
HCS (Home and Community-Based Services)
TxHmL (Texas Home Living)
CLASS (Community Living Assistance & Support Services)
DBMD (Deaf Blind with Multiple Disabilities Program)
YES Waiver – Limited equipment access for behavioral health needs
MDCP (Medically Dependent Children Program) – With coordination from a therapist
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: TMHP and HHSC Contract Application
Timeline: 2–4 months
Phase: Staff Onboarding & Vendor Agreements
Timeline: 30–60 days
Phase: Readiness Review & Equipment Referrals
Timeline: Services begin following contract execution and participant authorization
9. CONTACT INFORMATION
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Texas Health and Human Services Commission (HHSC)
Waiver Services: https://www.hhs.texas.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX ADAPTIVE EQUIPMENT SERVICES PROVIDER
WCG helps equipment vendors and providers get approved to deliver adaptive and assistive technology under Texas Medicaid waiver programs.
Scope of Work:
TMHP and HHSC enrollment support
Equipment procurement and delivery documentation templates
Adaptive Equipment Services Policy Manual
Clinical assessment coordination tools (OT/PT templates)
Installation checklists and client instruction logs
Authorization tracking sheets and billing forms
Repair and replacement logs for compliance audits
Skilled Nursing
SKILLED NURSING SERVICES PROVIDER IN TEXAS
DELIVERING CLINICALLY SUPERVISED CARE IN HOME AND COMMUNITY SETTINGS TO PROMOTE HEALTH, SAFETY, AND STABILITY FOR MEDICAID WAIVER PARTICIPANTS
Skilled Nursing Services in Texas are medically necessary, clinically supervised interventions delivered by licensed nursing professionals. These services are authorized through both the Texas Medicaid State Plan and 1915(c) Home and Community-Based Services (HCBS) Waiver Programs, such as HCS, CLASS, TxHmL, DBMD, and MDCP, and are coordinated under the oversight of the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Oversees nursing service authorization, provider enrollment, and Medicaid reimbursement under waiver and state plan programs.
Agency: Texas Board of Nursing (BON)
Role: Regulates nursing licensure, scope of practice, and clinical standards in Texas.
Agency: Texas Department of State Health Services (DSHS)
Role: Issues licenses for Home and Community Support Services Agencies (HCSSAs), which include skilled nursing services.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Sets national requirements for Medicaid nursing services and HCBS program compliance.
2. SKILLED NURSING SERVICES OVERVIEW
Skilled Nursing Services consist of medically necessary, goal-driven care performed by an RN or LPN/LVN under a physician’s order or care plan. These services are used to treat, manage, or monitor health conditions, prevent complications, and promote independence.
Examples of skilled interventions include:
Medication administration (including injections and IV therapy)
Wound care and dressing changes
Tracheostomy and ventilator care
Catheter and ostomy care
G-tube feeding and monitoring
Vital signs monitoring and clinical assessments
Health education and caregiver training
Coordination with primary care and specialists
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for licensure as a Home and Community Support Services Agency (HCSSA) through the Texas DSHS
Enroll as a Medicaid provider via TMHP (Texas Medicaid & Healthcare Partnership)
Apply for HHSC contract approval under specific waivers (e.g., HCS, CLASS)
Ensure compliance with nurse delegation and supervision rules
Develop a Skilled Nursing Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form your business entity, secure EIN/NPI
Step 2: Apply for a HCSSA license through DSHS, designating "Licensed and Certified Home Health Services"
Step 3: Enroll with TMHP as a Medicaid provider
Step 4: Apply for HHSC waiver contracts (HCS, CLASS, etc.)
Step 5: Complete readiness review and begin accepting physician referrals and ISP-based authorizations
5. REQUIRED DOCUMENTATION
Business registration, EIN, and NPI confirmation
HCSSA licensure from DSHS
Proof of Medicaid enrollment via TMHP
Professional liability and general insurance
Skilled Nursing Services Policy Manual including:
Clinical protocols for skilled procedures (e.g., wound care, G-tube management)
RN supervisory standards and nurse delegation processes
Care planning and service documentation templates
Emergency preparedness and infection control policies
Incident reporting, client rights, and medication management
Billing logs and physician order forms
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN)
Requirements: Active Texas license; responsible for assessments, care plans, delegation, and clinical supervision
Role: Licensed Vocational Nurse (LVN/LPN)
Requirements: Texas licensure; provides direct care under RN supervision and physician orders
Role: Clinical Administrator / Director of Nursing
Requirements: RN with supervisory experience in home health or HCBS settings
All clinical staff must complete:
Orientation to HCBS Medicaid and waiver programs
HIPAA, abuse prevention, and documentation compliance
Infection control, safety, and medication management
Annual competencies, CPR, and emergency training
Nurse delegation and task supervision procedures
7. MEDICAID WAIVER PROGRAMS
Skilled Nursing Services are reimbursable under:
HCS (Home and Community-Based Services)
CLASS (Community Living Assistance & Support Services)
TxHmL (Texas Home Living) – with clinical justification
DBMD (Deaf Blind with Multiple Disabilities Program)
MDCP (Medically Dependent Children Program)
Texas Medicaid State Plan – for short-term home health episodes
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensure Application
Timeline: 2–4 months (including HCSSA application and inspection)
Phase: TMHP Medicaid Enrollment
Timeline: 1–2 months
Phase: HHSC Waiver Contract Application
Timeline: 2–3 months
Phase: Staff Onboarding & Referral Acceptance
Timeline: Upon contract approval and service authorization
9. CONTACT INFORMATION
Texas Department of State Health Services (DSHS) – HCSSA Licensure
Website: https://www.dshs.texas.gov
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Texas Board of Nursing (BON)
Website: https://www.bon.texas.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX SKILLED NURSING PROVIDER
WCG supports licensed nurses, RN-led agencies, and HCSSAs with Medicaid waiver navigation and skilled care documentation systems.
Scope of Work:
HCSSA licensure application and compliance setup
TMHP and HHSC waiver provider enrollment
Skilled Nursing Policy & Procedure Manual
Nurse delegation logs, medication administration records, and care plans
Physician order templates and visit documentation forms
Compliance audit checklists and supervision tools
Habilitation
HABILITATION SERVICES PROVIDER IN TEXAS
TEACHING DAILY LIVING SKILLS, PROMOTING INDEPENDENCE, AND SUPPORTING COMMUNITY LIVING FOR INDIVIDUALS WITH DISABILITIES
Habilitation Services in Texas help individuals with intellectual and developmental disabilities (IDD) acquire, retain, and improve self-help, socialization, and adaptive skills necessary for daily life. These services are provided under various 1915(c) Medicaid Waiver Programs, including HCS, CLASS, TxHmL, and DBMD, and are regulated by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Oversees Medicaid waiver services, including contracting, monitoring, and reimbursement for habilitation providers.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal Medicaid standards for habilitative supports under HCBS programs.
2. HABILITATION SERVICES OVERVIEW
Habilitation services are designed to help individuals with disabilities develop and maintain functional abilities for independent living and community inclusion.
Service types include:
In-Home Habilitation: Teaching ADLs such as bathing, dressing, and meal prep
Community-Based Habilitation: Navigating public spaces, social skill-building
Health and Safety Skill Development: Medication routines, recognizing danger, hygiene
Communication Skill Enhancement: Using assistive devices, verbal and nonverbal strategies
Household Management: Budgeting, laundry, organizing, and basic cleaning
Behavioral Supports (if integrated): Managing frustration, following routines
Services are goal-based, tied to the individual’s Person-Directed Plan (PDP) or Individual Plan of Care (IPC).
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a provider with TMHP (Texas Medicaid & Healthcare Partnership)
Apply for contracts with HHSC for waiver programs offering habilitation
Maintain general liability and workers’ comp insurance
Create a Habilitation Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form your business entity and obtain EIN/NPI
Step 2: Enroll with TMHP as a Medicaid waiver provider
Step 3: Submit HHSC waiver program contract application (HCS, CLASS, etc.)
Step 4: Complete documentation submission, staff credentialing, and readiness review
Step 5: Begin receiving PDP/IPC-aligned service authorizations
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
TMHP and HHSC enrollment approvals
Insurance certificates
Habilitation Services Policy Manual including:
Participant skill acquisition planning
Daily documentation and service tracking
Staff training and supervision protocols
Incident prevention, response, and reporting systems
Community integration and inclusion standards
Participant rights and HIPAA-compliant forms
Medicaid billing templates
6. STAFFING REQUIREMENTS
Role: Habilitation Specialist / Direct Support Professional (DSP)
Requirements: High school diploma or GED, CPR/First Aid, background check, waiver-specific training
Role: Habilitation Supervisor (optional for teams or multi-site programs)
Requirements: Experience with IDD population, documentation oversight, goal tracking
All staff must complete:
Abuse, neglect, and exploitation prevention training
Participant rights and person-centered practices
Activity-specific skills instruction training
Daily documentation and safety protocols
Community engagement and transportation safety (if applicable)
7. MEDICAID WAIVER PROGRAMS
Habilitation is reimbursable under:
HCS (Home and Community-Based Services)
CLASS (Community Living Assistance and Support Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
YES Waiver – Through intensive community-based supports for children with SED
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Preparation
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Contracting
Timeline: 2–3 months
Phase: Staff Hiring, Training & Compliance Setup
Timeline: 30–60 days
Phase: Begin Services with Participant Referrals
Timeline: Upon receipt of authorizations and readiness confirmation
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX HABILITATION SERVICES PROVIDER
WCG supports habilitation providers in launching and scaling their waiver-compliant businesses across Texas.
Scope of Work:
TMHP and HHSC waiver enrollment support
Custom Habilitation Policy & Procedure Manual
Participant goal tracking and documentation templates
Daily service logs and behavior support tools
Training checklists, staff files, and supervision documentation
Billing tools and Medicaid compliance tracking
Personal Emergency Response System (PERS)
PERSONAL EMERGENCY RESPONSE SERVICES (PERS) PROVIDER IN TEXAS
ENHANCING SAFETY, INDEPENDENCE, AND IMMEDIATE ACCESS TO ASSISTANCE FOR INDIVIDUALS AT RISK IN HOME AND COMMUNITY SETTINGS
Personal Emergency Response Services (PERS) are Medicaid-funded systems that allow waiver participants—particularly those who are elderly, medically fragile, or living alone—to summon help during emergencies. These services are available under various 1915(c) HCBS Waiver Programs, including MDCP, CLASS, and STAR+PLUS, and are overseen by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Authorizes, approves, and reimburses PERS services under HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures federal Medicaid compliance for PERS within the scope of HCBS programs.
2. PERS SERVICES OVERVIEW
PERS is a 24/7 electronic monitoring system that enables individuals to secure help at the press of a button. It includes equipment installation, participant instruction, ongoing monitoring, and response coordination with emergency personnel or caregivers.
Covered services include:
Provision and installation of the PERS unit (landline, cellular, or wearable device)
24-hour monitoring by a live response center
Emergency call management and alerting caregivers or 911
Backup battery, testing, and troubleshooting
Optional add-ons: fall detection, GPS tracking, medication reminders (if authorized)
PERS is intended only for individuals who live alone or are alone for significant portions of the day, with medical or functional needs that place them at risk.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a Medicaid provider through TMHP (Texas Medicaid & Healthcare Partnership)
Apply for provider approval through HHSC for relevant waivers (e.g., MDCP, CLASS)
Maintain liability and equipment insurance
Partner with or operate a 24/7 response center
Develop a PERS Policy & Procedure Manual outlining service protocols
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and secure EIN/NPI
Step 2: Enroll with TMHP as a Medicaid provider
Step 3: Apply to HHSC for waiver-specific PERS service approval
Step 4: Submit documentation for monitoring system, installer background checks, and emergency response process
Step 5: Complete HHSC readiness review and begin receiving referrals
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI confirmation
TMHP enrollment confirmation and HHSC contract
Certificate of insurance (liability, equipment coverage)
PERS Policy Manual including:
Installation protocol and user training checklist
Monitoring system configuration and emergency alert process
Monthly testing, maintenance, and troubleshooting logs
Staff response timelines and call documentation
Participant rights, privacy protections, and escalation procedures
Service discontinuation, loss, or replacement policies
Billing and authorization tracking forms
6. STAFFING REQUIREMENTS
Role: Installer / Field Technician
Requirements: Background check, CPR/First Aid, training in device use and participant instruction
Role: Response Center Operator
Requirements: Experience in emergency communication, HIPAA compliance, real-time documentation
All staff must complete:
PERS device training and troubleshooting
Participant instruction and communication protocols
HIPAA, abuse prevention, and emergency escalation procedures
24/7 coverage staffing schedules
7. MEDICAID WAIVER PROGRAMS
PERS is a covered service under:
MDCP (Medically Dependent Children Program)
CLASS (Community Living Assistance & Support Services)
STAR+PLUS HCBS Waiver – For eligible adults with chronic or disabling conditions
PACE Programs – May include PERS-like functionality through care coordination
8. TIMELINE TO LAUNCH
Phase: Business Setup & Monitoring Partnership Establishment
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Application
Timeline: 2–3 months
Phase: Device Inventory, Installer Training, and Readiness
Timeline: 30–45 days
Phase: Service Activation & Referral Intake
Timeline: Following contract execution and participant authorization
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX PERS PROVIDER
WCG supports technology vendors, response centers, and DME providers in launching Medicaid-compliant PERS services across Texas.
Scope of Work:
TMHP and HHSC enrollment assistance
Partnership templates for monitoring centers
PERS Policy & Procedure Manual
Installation logs, participant training forms, and emergency escalation templates
Monthly testing and service tracking logs
Medicaid billing, service authorization, and inventory tools
Assistive Technology
ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN TEXAS
ENABLING INDEPENDENCE THROUGH SPECIALIZED DEVICES AND TRAINING THAT ENHANCE FUNCTIONAL ABILITY FOR INDIVIDUALS WITH DISABILITIES
Assistive Technology (AT) Services in Texas provide adaptive devices and related support to help individuals with disabilities perform tasks they would otherwise be unable to do independently. These services are available under several 1915(c) Medicaid Waiver Programs, including CLASS, DBMD, and HCS, and are administered by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Approves and authorizes assistive technology through HCBS waiver programs; ensures service plans align with participant needs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Regulates Medicaid-funded AT devices and services under federal waiver guidelines.
2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW
Assistive Technology includes any item, device, software, or system used to increase, maintain, or improve the functional capabilities of individuals with disabilities.
Common services and devices include:
Adaptive communication tools (e.g., speech-generating devices)
Modified keyboards, tablets, or touchscreens
Electronic medication reminders or tracking devices
Mobility-related controls or switches
Specialized apps or software for learning or task management
Installation and training on how to use the device
Repair and maintenance of covered equipment
All devices must be prescribed based on a professional assessment and outlined in the participant’s Individual Plan of Care (IPC) or Person-Directed Plan (PDP).
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Apply for HHSC waiver program contracts that cover AT services (e.g., CLASS, DBMD)
Maintain general liability insurance
Partner with certified AT professionals or therapists
Develop an Assistive Technology Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register business and obtain EIN/NPI
Step 2: Enroll with TMHP as a Medicaid waiver provider
Step 3: Apply for HHSC contracts with AT listed as a service
Step 4: Submit qualifications of staff/vendors, device procurement processes, and delivery protocols
Step 5: Complete readiness review and begin receiving service authorizations
5. REQUIRED DOCUMENTATION
Articles of Incorporation, EIN, NPI
TMHP and HHSC waiver approvals
Insurance coverage documentation
AT Services Policy Manual including:
Assessment and recommendation process
Purchase and delivery procedures
Device training and usage instruction guides
Repair and maintenance documentation
Participant safety and device sanitation procedures
HIPAA and participant confidentiality policies
Billing templates and AT inventory logs
6. STAFFING REQUIREMENTS
Role: Assistive Technology Specialist / Provider
Requirements: Knowledge or certification in AT; may include OTs, SLPs, or vendor-trained specialists
Role: Service Coordinator / Trainer
Requirements: Experience in device education, training, and participant support
All staff must complete:
HIPAA, safety, and confidentiality training
Abuse/neglect prevention
Device-specific training for evaluation and setup
Documentation and service tracking education
Note: Some waiver programs may require a therapist (OT/PT/SLP) to make the recommendation before AT is approved.
7. MEDICAID WAIVER PROGRAMS
Assistive Technology is reimbursable under:
CLASS (Community Living Assistance and Support Services)
DBMD (Deaf Blind with Multiple Disabilities)
HCS (Home and Community-based Services) – for certain adaptive items and services
TxHmL (Texas Home Living) – with limitations
YES Waiver – based on youth goals and plan of care
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Contracting
Timeline: 2–3 months
Phase: Staff/Contractor Training & Documentation Setup
Timeline: 30–45 days
Phase: Begin Services Post-Authorization
Timeline: Upon participant-specific request and HHSC approval
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX ASSISTIVE TECHNOLOGY PROVIDER
WCG supports therapy agencies, DME providers, and tech-focused care teams to launch Assistive Technology services under Medicaid waiver programs.
Scope of Work:
TMHP enrollment and waiver contracting
Policy Manual development with AT assessment templates
Equipment recommendation, delivery, and training documentation
Authorization trackers and Medicaid billing forms
Staff training and client education tools
Safety checklists and repair log templates
Behavioral Health
BEHAVIORAL HEALTH SERVICES PROVIDER IN TEXAS
PROMOTING EMOTIONAL WELL-BEING AND STABILITY FOR INDIVIDUALS WITH COMPLEX MENTAL HEALTH OR DEVELOPMENTAL NEEDS
Behavioral Health Services in Texas support individuals with mental health challenges, intellectual or developmental disabilities (IDD), and co-occurring disorders. These services help individuals manage behaviors, develop coping skills, and improve functioning at home and in the community. Behavioral health supports are authorized through various Medicaid programs, including 1915(c) HCBS Waivers (e.g., HCS, TxHmL, CLASS, DBMD), STAR Health, YES Waiver, and the Medicaid State Plan.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers Medicaid behavioral health benefits and oversees waiver-based behavioral support services.
Agency: Local Mental Health Authorities (LMHAs)
Role: Coordinate service access, crisis stabilization, and psychiatric assessments for non-waiver Medicaid programs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures federal compliance with Medicaid-funded behavioral health interventions and care standards.
2. BEHAVIORAL HEALTH SERVICES OVERVIEW
Behavioral Health Services aim to reduce maladaptive behaviors, build self-regulation skills, and support community integration for individuals with disabilities or mental health diagnoses.
Service types include:
Behavioral Support Services (Waiver-Based):
Functional behavioral assessments (FBAs)
Positive behavior support plan (PBSP) development
Behavior management training for caregivers and staff
Monitoring and plan revisions based on progress
Mental Health Services (State Plan or YES Waiver):
Psychiatric assessment and medication management
Individual and group counseling
Crisis stabilization services
Peer support and wraparound planning (youth)
Coaching and Skill-Building:
Emotional regulation strategies
Social skills and relationship building
Problem-solving and adaptive behavior reinforcement
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for HHSC waiver contracts (e.g., HCS, CLASS) and/or enroll with a Local Mental Health Authority
Employ or contract with licensed professionals (LPC, LCSW, BCBA, LMFT, psychologist)
Maintain general and professional liability insurance
Develop a Behavioral Health Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register business entity and secure EIN/NPI
Step 2: Enroll with TMHP and apply for HHSC waiver contracts
Step 3: Submit staff qualifications, behavior support credentials, and sample behavior support plans
Step 4: Complete readiness review and compliance check
Step 5: Begin providing services to participants upon authorization
5. REQUIRED DOCUMENTATION
EIN, NPI, formation documents
TMHP and HHSC provider approvals
Professional licensing verification for staff (LPC, BCBA, etc.)
Behavioral Health Policy Manual including:
FBA and PBSP development guidelines
Consent forms and HIPAA confidentiality policies
Documentation templates (session notes, progress tracking, incident reports)
Emergency intervention protocols and staff training logs
Cultural competency, trauma-informed care, and rights protection procedures
Medicaid billing templates and clinical supervision documentation
6. STAFFING REQUIREMENTS
Role: Licensed Behavior Specialist / Clinician
Requirements: Licensed LPC, LCSW, BCBA, psychologist, or LMFT with Medicaid eligibility
Role: Behavior Support Assistant (for plan implementation)
Requirements: Training in PBSPs, documentation, CPR/First Aid, abuse prevention
Role: Program Director / Supervisor
Requirements: Behavioral health experience, waiver program knowledge, staff oversight
All staff must complete:
Abuse, neglect, and exploitation prevention
Positive behavior support techniques and trauma-informed care
HIPAA, participant rights, and confidentiality training
Emergency safety intervention training (if applicable)
Documentation and Medicaid compliance training
7. MEDICAID WAIVER PROGRAMS
Behavioral Health and Behavioral Support Services are covered under:
HCS (Home and Community-based Services)
TxHmL (Texas Home Living)
CLASS (Community Living Assistance and Support Services)
DBMD (Deaf Blind with Multiple Disabilities)
YES Waiver (Youth Empowerment Services) – Mental health wraparound for youth
STAR Health / STAR Kids / STAR+PLUS – State Plan behavioral health coverage
8. TIMELINE TO LAUNCH
Phase: Business Formation & Staff Credentialing
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Contracting
Timeline: 2–3 months
Phase: Policy Manual & Clinical Readiness Prep
Timeline: 30–45 days
Phase: Begin Service Delivery Upon Authorization
Timeline: After participant plans are approved and services added to IPC or PDP
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Local Mental Health Authorities (LMHAs)
Directory: https://www.hhs.texas.gov/services/mental-health-substance-use/mental-health-crisis-services
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX BEHAVIORAL HEALTH PROVIDER
WCG helps therapists, clinics, and behavior support providers launch and expand Medicaid-compliant behavioral services across Texas.
Scope of Work:
TMHP enrollment and HHSC waiver contracting
Behavioral Health Policy & Procedure Manual
FBA and PBSP templates
Incident logs and clinical documentation tools
HIPAA and safety training forms
Medicaid billing and supervision tracking tools
Environmental Modification
ENVIRONMENTAL MODIFICATION SERVICES PROVIDER IN TEXAS
CREATING SAFE, ACCESSIBLE, AND SUPPORTIVE LIVING SPACES TO PROMOTE INDEPENDENCE FOR INDIVIDUALS WITH DISABILITIES
Environmental Modification Services (also known as home or residential modifications) are physical adaptations to the home or other environments that ensure health, safety, accessibility, and promote greater independence for individuals receiving Medicaid waiver services. These services are available under Texas 1915(c) HCBS Waiver Programs, including CLASS, DBMD, and MDCP, and are overseen by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers waiver programs, authorizes environmental modifications, and oversees service delivery.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures compliance with federal Medicaid HCBS regulations regarding allowable home modifications.
2. ENVIRONMENTAL MODIFICATION SERVICES OVERVIEW
Environmental Modifications are physically installed changes to a home or other living environment that help individuals with functional limitations safely remain in their community.
Examples of approved modifications include:
Wheelchair ramps, widened doorways, or accessible entrances
Roll-in showers, grab bars, raised toilets, and bathroom handrails
Specialized flooring to reduce falls or accommodate mobility devices
Lowered countertops or accessible appliances
Voice-activated switches or adaptive lighting
Emergency alert or backup systems related to environmental safety
Structural modifications for stability, including handrails and non-slip surfaces
Note: All modifications must be based on a professional assessment (e.g., OT/PT), included in the Individual Plan of Care (IPC) or Person-Directed Plan (PDP), and meet safety and construction codes.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Apply for HHSC provider approval for relevant waivers (e.g., CLASS, MDCP, DBMD)
Partner with or subcontract licensed general contractors (when applicable)
Maintain general liability and workers’ compensation insurance
Develop an Environmental Modification Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register business and secure EIN/NPI
Step 2: Enroll with TMHP as a Medicaid provider
Step 3: Apply for waiver-specific provider approval through HHSC
Step 4: Submit sample project documentation, staff/contractor qualifications, and inspection processes
Step 5: Complete readiness review and begin receiving service authorizations
5. REQUIRED DOCUMENTATION
Business formation documents, EIN, NPI confirmation
TMHP and HHSC enrollment approvals
Insurance certificates (liability, worker’s comp, vehicle)
Environmental Modification Policy Manual including:
Assessment and bid submission procedures
Contractor licensing and project documentation standards
Inspection protocols and photo documentation of completed work
Participant safety and temporary accommodation procedures
Maintenance education and warranty documentation
Billing templates and authorization tracking tools
HIPAA and participant rights procedures
6. STAFFING REQUIREMENTS
Role: Environmental Modification Coordinator
Requirements: Experience in project oversight, Medicaid documentation, construction terminology
Role: Licensed Contractor / Construction Specialist
Requirements: General contractor license (if performing structural work), liability insurance, background check
Optional Role: OT/PT Consultant
Purpose: Evaluates accessibility needs and recommends appropriate modifications
All personnel must follow:
HHSC guidelines for project safety and compliance
Documentation and photograph requirements
OSHA, ADA, and local building code standards
Timely completion and cleanup policies
7. MEDICAID WAIVER PROGRAMS
Environmental Modifications are covered under:
CLASS (Community Living Assistance and Support Services)
MDCP (Medically Dependent Children Program)
DBMD (Deaf Blind with Multiple Disabilities Program)
YES Waiver – Some limited modifications for children in community settings
Note: HCS and TxHmL use Residential Support Services for structural needs via licensed homes, not direct Environmental Modifications.
8. TIMELINE TO LAUNCH
Phase: Business Setup & Contractor Partnerships
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Contracting
Timeline: 2–3 months
Phase: Manual Development & Project Readiness Tools
Timeline: 30–45 days
Phase: Begin Services Upon Referral
Timeline: Once authorized modifications are approved via PDP or IPC
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX ENVIRONMENTAL MODIFICATION PROVIDER
WCG assists Medicaid waiver providers, DME suppliers, and construction firms in launching environmental modification services under Texas HCBS waiver programs.
Scope of Work:
TMHP and HHSC waiver enrollment
Sample contractor MOU and licensing verification tools
Environmental Modification Policy & Procedure Manual
Bid, inspection, and photo documentation templates
Authorization tracking and billing support tools
Contractor safety checklist and participant consent templates
Therapy
THERAPY SERVICES PROVIDER IN TEXAS
DELIVERING REHABILITATIVE AND HABILITATIVE THERAPIES TO SUPPORT FUNCTIONAL INDEPENDENCE, COMMUNICATION, AND MOBILITY FOR TEXANS IN HOME AND COMMUNITY SETTINGS
Therapy Services under Texas Medicaid waiver programs include Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) designed to restore, maintain, or enhance functional ability for individuals with disabilities or chronic conditions. These services are available through the Texas Health and Human Services Commission (HHSC) under multiple 1915(c) HCBS waiver programs including HCS, CLASS, TxHmL, DBMD, and MDCP.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Manages waiver programs, authorizes services, and contracts with therapy providers.
Agency: Texas Department of Licensing and Regulation (TDLR) & Texas State Board of Examiners
Role: Licenses and regulates PTs, OTs, and SLPs practicing in Texas.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Oversees federal Medicaid guidelines for rehabilitative and habilitative services.
2. THERAPY SERVICES OVERVIEW
Waiver-funded therapy services are goal-oriented interventions to support motor skills, communication, daily living activities, and community participation. Services may be:
Rehabilitative: Aimed at restoring lost function after illness or injury
Habilitative: Teaching skills not yet acquired (common in IDD populations)
Covered therapies may include:
Physical Therapy (PT): Mobility, balance, strength, coordination
Occupational Therapy (OT): Fine motor skills, ADLs, sensory integration
Speech-Language Pathology (SLP): Communication, speech production, swallowing, augmentative communication
Therapy must be prescribed by a physician, linked to the individual’s IPC or PDP, and support functional outcomes.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Ensure therapists hold active Texas licenses in their respective fields
Enroll with TMHP (Texas Medicaid & Healthcare Partnership) as a therapy provider
Apply for HHSC waiver program contracts (e.g., HCS, CLASS, MDCP)
Maintain professional liability insurance
Develop a Therapy Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form your entity, obtain EIN/NPI
Step 2: Register therapists with Texas licensing boards
Step 3: Enroll via TMHP as a Medicaid therapy provider
Step 4: Apply for waiver program contracts through HHSC
Step 5: Complete readiness review and begin accepting authorizations
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI
Texas licensure for PT, OT, or SLP providers
Liability insurance and Medicaid enrollment confirmation
Therapy Services Policy Manual including:
Service plan development and treatment goal tracking
Physician order documentation and renewal schedules
Progress note templates and reassessment protocols
Consent and HIPAA compliance forms
Emergency protocols and risk mitigation
Billing log and service authorization management
6. STAFFING REQUIREMENTS
Role: Licensed Physical Therapist (PT)
Requirements: Texas PT license; creates treatment plans and delivers mobility-related interventions
Role: Licensed Occupational Therapist (OT)
Requirements: Texas OT license; addresses fine motor skills, self-help, and environmental adaptations
Role: Speech-Language Pathologist (SLP)
Requirements: Texas license; supports speech, language, and swallowing function
Role: Therapy Assistant (PTA, OTA, SLPA)**
Requirements: Licensed and supervised by a primary therapist per board regulations
All staff must complete:
Waiver-specific training and Medicaid documentation procedures
Person-centered planning and ISP goal alignment
HIPAA and abuse prevention protocols
CPR/First Aid and emergency readiness (as required by service setting)
7. MEDICAID WAIVER PROGRAMS
Therapy services are available through:
HCS (Home and Community-Based Services)
CLASS (Community Living Assistance & Support Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities Program)
MDCP (Medically Dependent Children Program)
YES Waiver – For youth with serious emotional disturbances needing SLP/OT/PT supports
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Contracting
Timeline: 2–3 months
Phase: Staff Credentialing & Readiness Review
Timeline: 30–60 days
Phase: Begin Services
Timeline: Following receipt of service authorizations and ISP alignment
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Texas Board of Physical Therapy Examiners
Website: https://www.ptot.texas.gov
Texas State Board of Examiners for SLP and Audiology
Website: https://www.tdlr.texas.gov/slpa
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX THERAPY SERVICES PROVIDER
WCG helps therapists and therapy agencies establish Medicaid-approved services across Texas for HCBS and waiver populations.
Scope of Work:
TMHP and HHSC enrollment support
Therapy Services Policy & Procedure Manual
ISP-aligned documentation templates and progress tracking tools
HIPAA-compliant consent forms and evaluation templates
Sample treatment plan forms and physician order logs
Waiver-specific billing guides and staff supervision forms
Community Integration
COMMUNITY INTEGRATION SERVICES PROVIDER IN TEXAS
SUPPORTING INDIVIDUALS WITH DISABILITIES IN BUILDING SOCIAL CONNECTIONS, ENGAGING IN MEANINGFUL ACTIVITIES, AND PARTICIPATING FULLY IN THEIR COMMUNITIES
Community Integration Services are person-centered supports designed to help individuals with intellectual, developmental, or physical disabilities increase independence, build relationships, and access typical community life experiences. These services are funded under Texas Medicaid 1915(c) HCBS waiver programs, including HCS, CLASS, TxHmL, and DBMD, and are managed by the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Manages waiver programs, authorizes providers, and monitors service delivery for community-based supports.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures HCBS waiver services meet federal requirements for inclusion, integration, and person-centered outcomes.
2. COMMUNITY INTEGRATION SERVICES OVERVIEW
Community Integration helps participants learn, practice, and apply life skills in real-world environments—from volunteering and leisure activities to navigating transportation or attending local events. It promotes active citizenship and meaningful participation in society.
Core activities may include:
Social skill-building in group or 1:1 settings
Attending public events, clubs, or spiritual gatherings
Volunteerism, hobby groups, or recreational programs
Safety and etiquette in public spaces (libraries, parks, stores)
Navigating transportation, ordering food, managing money
Peer-to-peer interactions and developing natural supports
Person-centered planning and goal tracking for engagement
Note: Services must be based on individualized goals in the Person-Directed Plan (PDP) or Individual Plan of Care (IPC) and cannot duplicate other day or habilitation services.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a Medicaid provider via TMHP (Texas Medicaid & Healthcare Partnership)
Apply for waiver contracts under HHSC (HCS, CLASS, etc.)
Maintain general liability and auto insurance (if providing transport)
Develop a Community Integration Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Establish business entity and obtain EIN/NPI
Step 2: Enroll with TMHP as a Medicaid waiver provider
Step 3: Apply for waiver service contracts with HHSC
Step 4: Submit community integration service descriptions, staff training plans, and documentation tools
Step 5: Complete readiness review and begin service delivery per authorizations
5. REQUIRED DOCUMENTATION
EIN, NPI, Articles of Incorporation
TMHP enrollment and HHSC contract approval
Insurance certificates (general, auto, if applicable)
Community Integration Policy Manual including:
Person-centered planning and community activity mapping
Safety, transportation, and emergency protocols
Participant support plan documentation templates
Risk assessment and supervision policies
Consent, rights, and incident reporting protocols
Service note and participation tracking tools
COVID-19 and communicable disease mitigation (if needed)
6. STAFFING REQUIREMENTS
Role: Community Integration Support Specialist / DSP
Requirements: High school diploma or equivalent, experience supporting individuals with disabilities preferred, CPR/First Aid, background check
Role: Program Supervisor (optional, for oversight of multiple staff or programs)
Requirements: Experience in person-centered planning and community-based support coordination
All staff must complete:
HHSC waiver-specific training
Documentation and service note procedures
Abuse prevention and person-centered engagement
Emergency preparedness and community safety protocols
HIPAA and participant rights education
7. MEDICAID WAIVER PROGRAMS
Community Integration is a reimbursable service under:
HCS (Home and Community-Based Services)
CLASS (Community Living Assistance & Support Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
YES Waiver – Through intensive community-based supports for children with SED
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Application
Timeline: 2–3 months
Phase: Staff Onboarding & Readiness Preparation
Timeline: 30–60 days
Phase: Begin Services with Approved Authorizations
Timeline: Immediately upon HHSC approval and PDP/IPC authorization
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX COMMUNITY INTEGRATION PROVIDER
WCG helps local support providers, day programs, and nonprofit agencies get approved to deliver Medicaid-funded community integration services.
Scope of Work:
TMHP and HHSC waiver enrollment
Community Integration Policy & Procedure Manual
Activity tracking logs, participant support plan templates
Daily service note forms and safety protocols
Staff onboarding tools and transportation readiness checklists
Consent, rights, and incident reporting documentation
Homemaker
HOMEMAKER SERVICES PROVIDER IN TEXAS
SUPPORTING DAILY LIVING THROUGH LIGHT HOUSEKEEPING, MEAL PREPARATION, AND HOUSEHOLD TASKS FOR MEDICAID PARTICIPANTS IN HOME AND COMMUNITY SETTINGS
Homemaker Services in Texas help individuals who are elderly or have disabilities to maintain a safe and sanitary living environment. These services are part of the Home and Community-Based Services (HCBS) system and are available through various 1915(c) Medicaid Waiver Programs, including HCS, CLASS, DBMD, TxHmL, and STAR+PLUS HCBS. The Texas Health and Human Services Commission (HHSC) authorizes and monitors these services.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Approves homemaker services as a reimbursable support under Medicaid waivers, authorizes service plans, and monitors provider compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Regulates Medicaid funding and ensures federal standards are met for HCBS supports, including non-medical assistance services.
2. HOMEMAKER SERVICES OVERVIEW
Homemaker services are non-skilled, non-medical supports that help individuals manage basic household tasks they are unable to perform due to functional limitations.
Covered services include:
Sweeping, vacuuming, and light mopping
Dishwashing and cleaning kitchen surfaces
Laundry and linen changes
Bathroom cleaning and sanitization
Trash disposal
Meal preparation assistance (not direct feeding)
Grocery or household item organization (if within the home)
These services differ from Personal Care in that they do not include hands-on assistance with activities of daily living (ADLs) like bathing or dressing.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for HHSC waiver provider contracts (e.g., HCS, CLASS, DBMD)
Enroll as a provider with TMHP (Texas Medicaid & Healthcare Partnership)
Maintain liability insurance and workers’ comp
Create a Homemaker Services Policy & Procedure Manual
Note: No additional clinical license is required for non-skilled homemaker services.
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form legal business entity and acquire EIN/NPI
Step 2: Enroll with TMHP and apply for HHSC waiver contracts
Step 3: Submit staff qualifications, sample task logs, and safety protocols
Step 4: Complete readiness review and obtain provider approval
Step 5: Receive referrals and begin service delivery
5. REQUIRED DOCUMENTATION
Articles of incorporation, EIN, NPI
TMHP and HHSC waiver approvals
Insurance documentation
Homemaker Services Policy Manual including:
Participant intake and service authorization
Task logs and time tracking sheets
Sanitation and safety standards
Participant privacy and rights protections
Abuse/neglect prevention protocols
Documentation and Medicaid billing forms
6. STAFFING REQUIREMENTS
Role: Homemaker / Household Assistant
Requirements: Minimum age 18, background check, training in safe cleaning and privacy practices (no license required)
Role: Supervisor / Scheduler (optional)
Requirements: Experience with household management and service coordination
All staff must complete:
Orientation on homemaker responsibilities
HIPAA and participant confidentiality training
Abuse, neglect, and exploitation prevention
Documentation training for time sheets and task logs
Infection control and safe product use
7. MEDICAID WAIVER PROGRAMS
Homemaker Services are reimbursable through:
HCS (Home and Community-based Services)
TxHmL (Texas Home Living)
CLASS (Community Living Assistance and Support Services)
DBMD (Deaf Blind with Multiple Disabilities)
STAR+PLUS HCBS Waiver – Non-skilled home supports
MDCP (Medically Dependent Children Program) – When approved in the care plan
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Preparation
Timeline: 1–2 months
Phase: TMHP Enrollment & HHSC Waiver Contracting
Timeline: 2–3 months
Phase: Staff Training & Readiness Review
Timeline: 30–45 days
Phase: Start of Service Delivery
Timeline: Once referrals and authorizations are received
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX HOMEMAKER SERVICES PROVIDER
WCG supports homemaker service providers and attendant care agencies in building compliant, person-centered operations in Texas.
Scope of Work:
TMHP and HHSC waiver enrollment
Homemaker Services Policy Manual & safety checklists
Task documentation logs and time sheet templates
Staff orientation tools and training guides
HIPAA, abuse prevention, and supervision trackers
Medicaid billing system setup and form templates
Case Management
CASE MANAGEMENT SERVICES PROVIDER IN TEXAS
COORDINATING CARE, RESOURCES, AND SUPPORTS TO PROMOTE INDEPENDENT LIVING FOR MEDICAID WAIVER PARTICIPANTS ACROSS TEXAS
Case Management (also known as Service Coordination) is a critical support under Texas Medicaid waiver programs. It ensures that individuals with disabilities, chronic conditions, or complex needs receive coordinated, person-centered services in the most integrated settings. These services are available under various 1915(c) Home and Community-Based Services (HCBS) Waivers, including HCS, CLASS, DBMD, TxHmL, and MDCP.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers Medicaid waiver programs and contracts with providers for case management services.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures Texas waiver programs follow federal guidelines for conflict-free case management, service coordination, and participant rights.
2. CASE MANAGEMENT SERVICES OVERVIEW
Case Management Services involve assessment, service planning, coordination, monitoring, and advocacy to help individuals access needed Medicaid services, natural supports, and community resources.
Key activities include:
Conducting assessments and reassessments
Developing or updating the Individual Plan of Care (IPC) or Person-Directed Plan (PDP)
Coordinating waiver and non-waiver services (housing, employment, medical, behavioral)
Monitoring health, safety, and satisfaction through regular contact
Responding to crises or service interruptions
Supporting transitions (school to adult services, hospital to home, etc.)
Maintaining documentation for compliance and audits
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a Medicaid waiver provider through TMHP (Texas Medicaid & Healthcare Partnership)
Apply for contract approval through HHSC for the desired waiver programs
Demonstrate conflict-free status (you may not provide both case management and direct services to the same client)
Maintain liability insurance
Develop a Case Management Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Register business and obtain EIN/NPI
Step 2: Enroll with TMHP as a Medicaid provider
Step 3: Submit a provider application to HHSC under your chosen waiver program(s)
Step 4: Provide policy manuals, training plans, and documentation tools
Step 5: Complete HHSC readiness review and begin accepting participant assignments
5. REQUIRED DOCUMENTATION
Business registration, EIN, NPI confirmation
TMHP Medicaid enrollment and HHSC contract
Liability insurance and conflict-free provider documentation
Case Management Policy & Procedure Manual including:
Person-centered assessment and planning protocols
Contact schedule (home visits, calls, monitoring requirements)
Risk identification and crisis planning
Service authorization coordination
Incident reporting and participant rights documentation
Quality assurance procedures and audit readiness
HIPAA compliance and records retention guidelines
6. STAFFING REQUIREMENTS
Role: Case Manager / Service Coordinator
Requirements: Bachelor’s degree in social work, psychology, health, or human services field; experience with disability services or care coordination preferred
Role: Clinical Supervisor (if required for specific waivers)
Requirements: Advanced licensure (e.g., LMSW, LPC) may be needed for oversight
All staff must complete:
HHSC waiver program training
Person-centered planning and Medicaid documentation training
HIPAA, rights protections, and abuse prevention
Emergency planning and risk mitigation
Ongoing training in quality monitoring and outcomes tracking
7. MEDICAID WAIVER PROGRAMS
Case Management Services are included under:
CLASS (Community Living Assistance & Support Services)
HCS (Home and Community-Based Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
MDCP (Medically Dependent Children Program)
YES Waiver (Youth Empowerment Services) – Behavioral health coordination for children
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Creation
Timeline: 1–2 months
Phase: TMHP Medicaid Enrollment & HHSC Application
Timeline: 2–3 months
Phase: Staff Onboarding & Documentation Setup
Timeline: 30–60 days
Phase: Readiness Review & Client Assignment
Timeline: Once HHSC contracts are executed and referrals are made
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX CASE MANAGEMENT SERVICES PROVIDER
WCG helps care coordinators and case management agencies become authorized to provide Medicaid-funded service coordination in Texas.
Scope of Work:
TMHP and HHSC enrollment support
Conflict-free case management compliance templates
Person-centered planning forms and risk assessment tools
Case Management Services Policy & Procedure Manual
Staff onboarding tools and quality monitoring workflows
Visit logs, service tracking templates, and billing guides
Transportation
TRANSPORTATION SERVICES PROVIDER IN TEXAS
SUPPORTING ACCESS TO MEDICAL CARE, COMMUNITY ACTIVITIES, AND EMPLOYMENT FOR INDIVIDUALS WITH DISABILITIES
Transportation Services in Texas help individuals enrolled in Medicaid and Home and Community-Based Services (HCBS) Waiver programs travel to approved destinations such as medical appointments, day programs, job sites, or community events. These services fall under Non-Emergency Medical Transportation (NEMT), waiver-funded transportation, or Community First Choice (CFC) supports, and are managed by the Texas Health and Human Services Commission (HHSC) in partnership with regional transportation brokers and local waiver authorities.
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Manages Medicaid transportation policy and authorizes transportation as a waiver service.
Agency: Medical Transportation Program (MTP) – Operated by HHSC
Role: Provides NEMT services through designated brokers like Modivcare and Access2Care.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Oversees Medicaid transportation regulations, especially for HCBS waiver-related access.
2. TRANSPORTATION SERVICES OVERVIEW
Transportation services ensure individuals with disabilities or chronic health conditions have reliable, safe access to:
Medical appointments (doctors, dentists, therapies)
Day habilitation or community programs
Employment sites or vocational training
Medicaid waiver service locations
Pharmacy pickups or supply centers
Essential errands (if included in person’s Plan of Care)
Service types may include:
Door-to-door transport
Lift-equipped van rides
Accompaniment support (for riders with supervision needs)
Mileage reimbursement (if participant or family transports)
All trips must be authorized in the Individual Plan of Care (IPC) and meet Medicaid transport standards.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for Medicaid waiver contracts (e.g., HCS, CLASS, DBMD) through HHSC
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Comply with Texas Department of Motor Vehicles (TxDMV) for vehicle registration and commercial use
Obtain commercial auto insurance, general liability, and workers’ comp
Develop a Transportation Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and secure EIN/NPI
Step 2: Enroll with TMHP and apply for HHSC waiver contract with transportation service
Step 3: Prepare documentation of vehicle inspection, insurance, and staff credentials
Step 4: Pass readiness review and receive service authorizations
Step 5: Begin transporting participants according to waiver goals and schedules
5. REQUIRED DOCUMENTATION
EIN, NPI, Articles of Incorporation
Vehicle inspection certificates (TxDOT or state-approved inspection)
Commercial auto insurance policy
TMHP and HHSC approval letters
Driver background checks and driving records
Transportation Services Policy Manual including:
Trip logs and mileage reporting
Rider safety and lift training protocols
Participant rights and HIPAA during transport
Incident reporting and emergency procedures
Cleaning and sanitation of vehicles
Coordination with service providers and waiver teams
6. STAFFING REQUIREMENTS
Role: Driver / Transportation Aide
Requirements: Age 21+, clean driving record, CPR/First Aid, background check, defensive driving or vehicle safety training
Role: Program Manager / Dispatcher
Requirements: Trip scheduling, routing, communication with service coordinators, recordkeeping
All staff must complete:
HIPAA, abuse prevention, and documentation training
ADA vehicle operation and passenger lift safety
Emergency evacuation procedures
Client-specific support needs (if required)
7. MEDICAID WAIVER PROGRAMS
Transportation Services are reimbursable under:
HCS (Home and Community-based Services)
CLASS (Community Living Assistance & Support Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
YES Waiver – Youth community supports
STAR+PLUS HCBS – Medical and waiver service transport
MDCP (Medically Dependent Children Program)
Note: Non-waiver NEMT is accessed separately via Modivcare or Access2Care, not through provider billing.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Insurance Setup
Timeline: 1–2 months
Phase: TMHP & HHSC Waiver Contracting
Timeline: 2–3 months
Phase: Vehicle Inspection & Driver Training
Timeline: 30–45 days
Phase: Begin Services Upon Authorization
Timeline: Once assigned participants or schedule is approved
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Texas Department of Motor Vehicles (TxDMV)
Website: https://www.txdmv.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX TRANSPORTATION PROVIDER
WCG supports new and existing transportation providers in entering Medicaid waiver networks and complying with documentation, safety, and billing protocols.
Scope of Work:
Waiver enrollment through TMHP and HHSC
Transportation Policy Manual & trip documentation templates
Vehicle safety inspection guidance
Driver credentialing and tracking tools
Mileage logs, HIPAA forms, and incident templates
Referral pathways and scheduling strategies
Home Health
HOME HEALTH SERVICES PROVIDER IN TEXAS
DELIVERING SKILLED NURSING, THERAPIES, AND PERSONAL ASSISTANCE TO MEDICAID PARTICIPANTS IN THEIR OWN HOMES
Home Health Services in Texas include short-term or long-term skilled care and personal support delivered in a participant’s home, with the goal of preventing institutionalization, supporting recovery, and maintaining health. These services are available under both the Texas Medicaid State Plan and multiple 1915(c) Home and Community-Based Services (HCBS) Waiver Programs, including MDCP, CLASS, and STAR+PLUS HCBS, under the supervision of the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Administers Medicaid and HCBS programs, contracts with providers, and authorizes service delivery.
Agency: Texas Department of State Health Services (DSHS)
Role: Licenses Home and Community Support Services Agencies (HCSSAs), the official designation for home health providers.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Establishes federal regulations and quality standards for Medicaid-certified home health agencies.
2. HOME HEALTH SERVICES OVERVIEW
Home health services combine clinical care with daily living support, delivered by a team of licensed professionals and trained aides.
Services may include:
Skilled Nursing: Medication administration, wound care, catheter care, condition monitoring
Home Health Aide (HHA) Services: Personal hygiene, dressing, mobility, and nutritional support
Physical Therapy, Occupational Therapy, and Speech Therapy
Medical Social Work (if authorized)
Health education for participant and caregiver
Coordination of care and medical equipment support
All services must be medically necessary, prescribed by a physician, and approved as part of a care plan.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Apply for a Home and Community Support Services Agency (HCSSA) license via Texas DSHS
Choose “Licensed Home Health Services” as the service category
Enroll with TMHP (Texas Medicaid & Healthcare Partnership)
Apply to HHSC for contracts under relevant waiver programs
Maintain general, professional liability, and workers’ comp insurance
Create a Home Health Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and obtain EIN/NPI
Step 2: Apply for HCSSA licensure via DSHS (includes survey and fee)
Step 3: Enroll with TMHP for Medicaid reimbursement
Step 4: Apply for HHSC waiver contracts (MDCP, CLASS, STAR+PLUS, etc.)
Step 5: Pass readiness review and begin receiving referrals and authorizations
5. REQUIRED DOCUMENTATION
EIN, NPI, Articles of Incorporation
HCSSA license from Texas DSHS
TMHP enrollment confirmation
Liability and malpractice insurance policies
Home Health Policy & Procedure Manual including:
Plan of care development and physician order process
Medication management, infection control, and clinical protocols
Visit note templates and electronic documentation standards
Participant rights, HIPAA, and abuse prevention policies
Quality assurance, emergency preparedness, and incident tracking
Billing logs and authorization tracking forms
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN)
Requirements: Active Texas license; responsible for assessments, care plans, and supervision
Role: Licensed Vocational Nurse (LVN)
Requirements: Texas licensure; provides care under RN direction
Role: Home Health Aide (HHA)
Requirements: High school diploma or equivalent, CPR/First Aid, background check, HHA training (if not CNA)
Role: Therapists (PT, OT, SLP)**
Requirements: Active Texas license in respective discipline
Role: Clinical Administrator (for HCSSA)
Requirements: RN with supervisory experience (per DSHS rule)
All staff must complete:
Orientation on Medicaid, HHSC, and waiver rules
Abuse/neglect prevention, emergency procedures, and documentation standards
Annual skills competency and continuing education
7. MEDICAID WAIVER PROGRAMS
Home Health Services are authorized under:
MDCP (Medically Dependent Children Program)
CLASS (Community Living Assistance and Support Services)
STAR+PLUS HCBS Waiver
Deaf Blind with Multiple Disabilities (DBMD)
Traditional Medicaid (State Plan) – For post-hospitalization home health episodes
8. TIMELINE TO LAUNCH
Phase: Business Setup & Licensure Preparation
Timeline: 2–4 months (HCSSA process can be time-intensive)
Phase: Medicaid Enrollment & HHSC Contracting
Timeline: 2–3 months
Phase: Staff Hiring & Readiness Prep
Timeline: 30–60 days
Phase: Service Launch
Timeline: Begins after HHSC contract execution and participant assignment
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Department of State Health Services (DSHS) – HCSSA Licensure
Website: https://www.dshs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX HOME HEALTH PROVIDER
WCG supports nurses, therapy agencies, and clinical home care programs to launch Medicaid-compliant home health services in Texas.
Scope of Work:
HCSSA licensure and TMHP enrollment
Home Health Policy & Procedure Manual
Nurse delegation protocols and supervisory tools
Visit documentation, shift notes, and treatment log templates
Emergency response plans, participant rights materials, and QA checklists
Referral tracking and billing support tools
Meal & Nutrition
MEAL & NUTRITION SERVICES PROVIDER IN TEXAS
DELIVERING NUTRITIOUS, INDIVIDUALIZED MEALS TO PROMOTE HEALTH, STABILITY, AND INDEPENDENCE FOR WAIVER PARTICIPANTS ACROSS TEXAS
Meal & Nutrition Services are designed to meet the dietary needs of individuals with disabilities, chronic illnesses, or limited access to food preparation resources. These services are provided under Texas Medicaid’s 1915(c) Waiver Programs, including HCS, CLASS, TxHmL, DBMD, and MDCP, and are coordinated through the Texas Health and Human Services Commission (HHSC).
1. GOVERNING AGENCIES
Agency: Texas Health and Human Services Commission (HHSC)
Role: Oversees the authorization, reimbursement, and provider contracts for meal services in HCBS waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Regulates federal standards for nutrition-related services under Medicaid waivers.
2. MEAL & NUTRITION SERVICES OVERVIEW
Meal & Nutrition Services support individuals who are unable to shop for, prepare, or safely consume meals on their own. The service must be medically necessary, linked to an assessed need, and included in the Individual Plan of Care (IPC) or Person-Directed Plan (PDP).
Services may include:
Home-delivered meals tailored to dietary restrictions (diabetic, low-sodium, soft, etc.)
Meal preparation in the participant’s home by trained staff
Nutrition consultation or meal planning by a registered dietitian (if authorized)
Feeding assistance for individuals with physical or cognitive impairments
Coordination with medical needs (e.g., enteral nutrition may require nursing)
Waiver guidelines emphasize nutritious, balanced meals that align with individual health and cultural needs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a Medicaid provider through TMHP (Texas Medicaid & Healthcare Partnership)
Apply for contract approval under HHSC waivers offering meal services
Comply with local food handling laws and permits
Maintain liability insurance
Develop a Meal & Nutrition Services Policy & Procedure Manual
4. TEXAS PROVIDER ENROLLMENT PROCESS
Step 1: Form legal business entity and obtain EIN/NPI
Step 2: Enroll with TMHP as a Medicaid provider
Step 3: Apply with HHSC to become a provider under one or more waivers (e.g., HCS, CLASS, DBMD)
Step 4: Submit food safety certifications and meal preparation protocols
Step 5: Complete a readiness review and begin receiving service authorizations
5. REQUIRED DOCUMENTATION
Business registration, EIN, and NPI confirmation
Local health permit for food preparation (if preparing meals in-house)
Food handler certifications and background checks for staff
Liability insurance
Meal & Nutrition Services Policy & Procedure Manual including:
Nutritional standards and portion guidelines
Meal planning and individualized meal modification process
Sanitation and infection control protocols
Meal delivery verification forms and contact notes
Participant rights and grievance procedures
Record-keeping and audit-readiness templates
6. STAFFING REQUIREMENTS
Role: Meal Delivery Driver / Nutrition Aide
Requirements: Valid driver’s license, food handler certification, CPR/First Aid preferred
Role: Meal Preparer / Dietary Aide (if cooking in-house)
Requirements: Food safety certification, training in special dietary needs
Role: Registered Dietitian (optional but recommended)
Requirements: Licensed in Texas; provides consultations and menu reviews
All staff must complete:
HHSC-required waiver training (if applicable)
Food safety and sanitation training
Abuse prevention and emergency response training
HIPAA and participant confidentiality training
7. MEDICAID WAIVER PROGRAMS
Meal & Nutrition Services are available under:
CLASS (Community Living Assistance and Support Services)
HCS (Home and Community-Based Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
MDCP (Medically Dependent Children Program) – if nutritional support is authorized
YES Waiver – when meals are part of intensive family supports
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: TMHP & HHSC Enrollment
Timeline: 2–3 months
Phase: Staff Onboarding & Food Permit Approval
Timeline: 30–60 days
Phase: Service Authorization & Participant Assignment
Timeline: Begins after HHSC contract execution and case manager referral
9. CONTACT INFORMATION
Texas Health and Human Services Commission (HHSC)
Website: https://www.hhs.texas.gov
Texas Medicaid & Healthcare Partnership (TMHP)
Website: https://www.tmhp.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
Texas Department of State Health Services (DSHS)
(For local food permits)
Website: https://www.dshs.texas.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TX MEAL & NUTRITION SERVICES PROVIDER
WCG helps local kitchens, home meal delivery businesses, and HCBS providers launch Medicaid-funded nutrition services across Texas.
Scope of Work:
TMHP and HHSC enrollment support
Local food permit guidance and compliance templates
Meal & Nutrition Policy & Procedure Manual
Daily delivery logs, menu templates, and nutrition preference surveys
Dietitian partnership coordination tools (if applicable)
Billing documentation and service authorization tracking forms
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.