TITLE 26. HEALTH AND HUMAN SERVICES

PART 1. HEALTH AND HUMAN SERVICES COMMISSION

CHAPTER 331. LIDDA SERVICE COORDINATION

The executive commissioner of the Texas Health and Human Services Commission (HHSC) adopts amendments to §331.1, concerning Purpose; §331.3, concerning Application; §331.5, concerning Definitions; §331.7, concerning Eligibility; §331.9, concerning Funding Service Coordination; §331.11, concerning Designated LIDDA's Responsibilities; §331.13, concerning Caseloads; §331.15, concerning Termination of Service Coordination; §331.17, concerning Minimum Qualifications; §331.19, concerning Employee Training; §331.21, concerning Documentation of Service Coordination; and §331.23, concerning Review Process.

Sections 331.5, 331.11, and 331.19 are adopted with changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2917). These rules will be republished.

Sections 331.1, 331.3, 331.7, 331.9, 331.13, 331.15, 331.17, 331.21, and 331.23 are adopted without changes to the proposed text as published in the May 16, 2025, issue of the Texas Register (50 TexReg 2917). These rules will not be republished.

BACKGROUND AND JUSTIFICATION

The adopted rules implement House Bill (H.B.) 4, 87th Legislature, Regular Session, 2021, to ensure Medicaid recipients, child health care plan program enrollees, and other individuals receiving benefits under a public benefits program administered by HHSC or another health and human services agency have the option to receive services as telemedicine medical services, telehealth services, or other telecommunications or information technology to the extent it is cost effective and clinically effective. The adopted rules define terms pertaining to the implementation of H.B. 4, such as audio-only, audio-visual, and in person to make the meaning of these terms clear. The adopted rules update the documentation requirements for service coordination to identify if a contact with an individual is in person, by audio-visual communication, or by audio-only communication and the location of the contact.

The adopted rules update the minimum qualifications and training requirements for service coordinators, including training on person-centered service planning. These rules ensure that a service coordinator is qualified to provide service coordination. The adopted rules require the HHSC Service Coordination Assessment form to identify the frequency of in-person service coordination contacts an individual needs. This ensures that an individual receives more in-person contacts, if needed based on the Service Coordination Assessment. The adopted rules implement updated agency names and citations.

The adopted rules also update a citation to the Texas Government Code in the definition of "MCO--Managed care organization." The update is related to H.B. 4611, 88th Legislature, Regular Session, 2023, effective April 1, 2025, which made certain non-substantive revisions to Subtitle I of Title 4 of the Texas Government Code, which governs HHSC, Medicaid, and other social services as part of the legislature's ongoing statutory revision program.

COMMENTS

The 31-day comment period ended June 16, 2025.

During this period, HHSC received comments regarding the proposed rules from three commenters. HHSC received comments from Lubbock Adult Day Center, UT Southwestern Medical Center, and the Texas Council of Community Centers. A summary of comments relating to the rules and HHSC's responses follows.

Comment: One commenter supported the implementation of H.B. 4 from the 87th Legislative Session in 2021. The commenter went on to share that approximately 15 percent of Medicaid recipients in the state live in rural areas and have limited access to health care services. This commenter feels that H.B. 4 will increase rural residents' access to health care services.

Response: HHSC appreciates the support for the rule amendment.

Comment: One commenter expressed concern about people receiving service coordination virtually or by phone when they cannot communicate over the phone, cannot understand someone virtually, have difficulty communicating in person, or have difficulty hearing or speaking effectively. Another commenter requests clarification regarding the criteria to qualify for virtual meetings for service coordination. This commenter had a concern that if the service coordinator is left to decide who qualifies, this could lead to inconsistencies in service delivery.

Response: HHSC declines to make changes to the rule in response to these comments. HHSC recognizes that audio-only or audio-visual service coordination is not appropriate for everyone. The results of the Service Coordination Assessment, reviewed with the service planning team for accuracy, assist the team in determining the most appropriate frequency of in-person visits for each person. Further, a person or their legally authorized representative (LAR) must provide consent to receive service coordination via audio-only or audio-visual communication.

Comment: One commenter critiqued the statutory requirement that local intellectual and developmental disability authorities (LIDDAs) provide case management (referenced in the Texas Health and Safety Code as "service coordination") as being wasteful and leading to recipients receiving less than a "minimum standard of care" with no accountability. The commenter went on to raise concerns related to Intellectual or Developmental Disability (IDD) waiver program providers' responsibilities.

Response: Comments related to the formation of LIDDAs or IDD waiver program provider duties that are required by statute are outside the scope of this rule project. Texas Health and Safety Code §533A.035 requires the executive commissioner to designate LIDDAs for one or more local service areas. Under Texas Health and Safety Code §533A.0355(b), the executive commissioner must adopt rules regarding the LIDDA's service coordination functions. The Intellectual or Developmental Disability Ombudsman's office can address specific complaints about IDD waiver program providers or LIDDAs. HHSC did not revise the rules in response to this comment.

Comment: Regarding the definitions for "audio-only" and "audio-visual" in §331.5, a commenter requested HHSC provide training to LIDDAs on the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA) as stated in each definition.

Response: The comment does not require a change to the rule language and is outside the scope of this rule project. LIDDAs can consult with their privacy officers and legal departments to ensure compliance with all applicable rules in the Texas Administrative Code (TAC) requiring compliance with HIPAA.

Comment: A commenter asked how the inclusion of a nursing facility in the definition of "institution" in §331.5 interacts with service coordination provided as part of a LIDDA's responsibilities under Pre-admission Screening and Resident Review (PASRR), and asked if all contacts made in nursing facilities are treated as Habilitation Coordination. Another commenter asked how §331.7(a)(2) related to Eligibility, interacts with the provisions related to PASRR Habilitation Coordination.

Response: The inclusion in §331.5 of a nursing facility in the definition of "institution" is related to eligibility criteria in §331.7(a)(1)(A). However, §331.7(a)(1)(E) and (a)(2) also relate to the provision of service coordination in nursing facilities. The other comments are not related to the proposed rules in Chapter 331; and therefore, are outside the scope of this rule project. The responsibilities for a LIDDA related to PASRR and habilitation coordination are located in 26 TAC Chapter 303.

Comment: Regarding the definition of "plan of services and supports," a commenter requested clarification regarding "duration" in §331.5(29)(D).

Response: To clarify, the definition for "duration" is included in this rule language at §331.5(7). Also, as stated in the Person-Directed Plan (PDP), "Service coordination is provided for the duration the person is enrolled in Home and Community-based Services (HCS) or Texas Home Living (TxHmL)."

Comment: Regarding the definition of "service coordination" in §331.5, a commenter recommended revising the rule language to ensure the emphasis is on the person's preferences, not their LAR's.

Response: HHSC agrees and revised the definition of "service coordination" in §331.5 to specify "individual, or individual and LAR."

Comment: Regarding the definition of "service coordination," a commenter requested continued dialogue with HHSC to reach an understanding of the service coordinator's responsibility to monitor health and safety risks, including in environments where the person receives certain services.

Response: HHSC is interested in continued discussions with stakeholders regarding service coordination monitoring of certain service locations.

Comment: A commenter recommends replacing "the designated LIDDA" with "a designated LIDDA" in §331.7 to allow a receiving LIDDA during a transfer to use an HHSC Service Coordination Assessment form completed by the sending LIDDA until another assessment needs to be completed.

Response: HHSC declines to make the recommended change in §331.7 in response to this comment. A receiving LIDDA may not need to complete a new HHSC Service Coordination Assessment form to determine frequency of in-person contacts. The receiving LIDDA should review the current HHSC Service Coordination Assessment form completed by the sending LIDDA to determine if the information remains accurate. In addition, a new consent form for use of audio-only or audio-visual communication will be required.

Comment: One commenter asked if service coordination is prohibited when a person is anticipated to be in an institution for a short-term stay and what section of the TAC the prohibition is located in.

Response: HHSC declines to change the rule in response to this comment. The State Plan states that the target group for service coordination includes individuals who meet the criteria and are either transitioning to a community setting from an institution during the last 180 days of a covered long-term stay or individuals who require long-term care in the community. A person experiencing a short-term stay in an institution is not eligible for service coordination.

Comment: Regarding eligibility in §331.7(a)(1)(F) related to transitioning to the community from a state hospital or other HHSC-contracted psychiatric bed, a commenter asked if HHSC intends to include other institutional types in the eligibility criteria for service coordination.

Response: HHSC declines to revise the rule in response to this comment. HHSC has no plans to expand eligibility criteria for service coordination.

Comment: Regarding a person's desire for service coordination in §331.11(a) Designated LIDDA's Responsibilities, a commenter requested the rule language change to state, "and consents to receive service coordination."

Response: HHSC declines to revise the rule in response to this comment. Section 331.11(a) describes when and how the LIDDA should develop a plan of services and supports. Texas Health and Safety Code §593.002 provides that a LIDDA may not provide intellectual disability services to a client without the client's legally adequate consent.

Comment: Regarding crisis prevention and management in §331.11(c), one commenter asked if this was the only component of service coordination that could be provided without first being identified in the person's plan of services and supports. The commenter gave examples such as monitoring, assessment, and service planning and coordination, as outlined in the definition for service coordination.

Response: HHSC declines to revise the rule in response to this comment. Section 331.11(b) requires that service coordination be provided in accordance with the individual's plan of services and supports. The only exception to this is found in subsection (c) of the rule that allows for the crisis prevention and management component of service coordination to be provided without having first identified the need for such services in the plan of services and supports.

Comment: Regarding the requirement to use the HHSC Service Coordination Assessment form, a commenter suggests that the language in §331.11(e) and (e)(1) is saying the same thing.

Response: HHSC agrees and removed the language in §331.11(e)(1) as it is duplicative. HHSC then renumbered (e)(2) and (e)(3) as (e)(1) and (e)(2).

Comment: Regarding the completion of the Service Coordination Assessment in §331.11(e)(2), a commenter suggested that the rule language should be revised to ensure that the assessment is not completed without the involvement of the person receiving services.

Response: HHSC agrees and revised proposed §331.11(e)(2), renumbered as §331.11(e)(1), to change "with the individual or LAR when applicable" to "with the individual, or individual and LAR when applicable."

Comment: Regarding verbal consent for audio-only or audio-visual communication for service coordination encounters in §331.11(i)(2)(B), a commenter requested that the rule language include how long verbal consent is effective.

Response: HHSC agrees and added in §331.11(i)(2)(B) that verbal consent may only be effective for that encounter. Verbal or written consent must be obtained before the next encounter.

Comment: Regarding caseload size in §331.13, a commenter stated that available funding is a determining factor. This commenter pointed out that the rates for service coordination have not been revisited since their establishment on September 1, 2011, nearly 15 years ago.

Response: HHSC declines to make changes to the rules in response to this comment. Service coordination rates are outside the scope of this rule project. The rule language in §331.13 lists some factors in determining caseloads; however, "such as" means this is not an exhaustive list.

Comment: One commenter observed that the addition of "in-person contacts" in §331.13 regarding caseloads did not take virtual or phone meetings into consideration when determining service coordinators' caseloads.

Response: HHSC declines to make the requested change to the rules in response to this comment. The rule language in §331.13 lists some factors in determining caseloads; however, "such as" means this is not an exhaustive list. Therefore, contacts using audio-visual communication or audio-only communication could be taken into consideration by a LIDDA when determining caseloads.

Comment: One commenter asked how the provision at §331.15 related to Termination of Service Coordination interacts with the requirements for participation in the HCS and TxHmL waivers.

Response: This comment is outside the scope of this rule project. LIDDA responsibilities related to TxHmL and HCS are located in 26 TAC Chapter 262 and Chapter 263, respectively.

Comment: A commenter asked for clarification regarding the grandfathered language being removed from §331.17 Minimum Qualifications.

Response: HHSC would like to clarify that service coordinators hired prior to 1999 are grandfathered into the current minimum qualifications. As stated in §331.7(d), an employee hired to provide service coordination prior to October 16, 2022, is subject to the rules in effect at the time the employee was hired.

Comment: One commenter requests that the word "directly" be added to the rule language in §331.19(a)(2) to qualify that the employees who directly supervise the provision of service coordination are required to complete the listed trainings.

Response: HHSC agrees to the requested rule language change.

Comment: As proposed, §331.19(b)(1)(I) requires service coordinators to complete "additional trainings designated by HHSC." A commenter voiced a concern about this new training provision related to employee workload.

Response: HHSC declines to revise the rule language based on this comment. At times, especially during disasters or the implementation of new programs, it might be necessary for HHSC to require additional training for service coordinators to attend.

Comment: A commenter asked for the meaning of "non-introductory" relating to the requirements for person-centered planning training in §331.19(b)(2) regarding Employee Training.

Response: HHSC considers "non-introductory" to be a comprehensive person-centered planning training, not a class that simply gives a general overview of person-centered planning. The language "non-introductory" is also included in TxHmL and HCS rules in §262.701(g)(2) and §263.901(b)(2).

Comment: One commenter thanked HHSC for providing LIDDAs with the opportunity to request a six-month extension to complete person-centered planning training in §331.19(b)(2).

Response: HHSC appreciates the support for the rule amendment.

HHSC revised §331.5(20) to update a rule reference.

HHSC revised §331.11(a) to remove a space between the hyphenated word "person-centered."

HHSC revised §331.11(k) to use formatting and active voice to clarify the requirements in the rule for a LIDDA.

HHSC revised §331.19(b)(1) and (2) to replace "service coordinator's" with "employee's." The revisions clarify that a service coordinator's direct supervisors also need to complete the person-centered trainings by their date of hire.

STATUTORY AUTHORITY

The amendments are adopted under Texas Government Code §524.0151, which provides that the executive commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, and Texas Government Code §532.0051, which provides HHSC with the authority to administer federal funds and plan and direct the Medicaid program in each agency that operates a portion of the Medicaid program; Texas Government Code §548.0001, which requires that HHSC ensure that Medicaid recipients and individuals receiving benefits under a public benefits program have the option to receive services as telemedicine medical services, telehealth services, or otherwise using telecommunications or information technology; Texas Human Resources Code §32.021, which provides that HHSC will adopt necessary rules for the proper and efficient administration of the Medicaid program; and Texas Health and Safety Code §533A.0355(a), which provides that the executive commissioner of HHSC shall adopt rules establishing the roles and responsibilities of LIDDAs.

§331.5. Definitions.

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

(1) Actively involved person--For an individual who lacks the ability to provide legally adequate consent and who does not have an LAR, a person whose significant and ongoing involvement with the individual is determined by the individual's designated LIDDA to be supportive of the individual based on the person's:

(A) observed interactions with the individual;

(B) knowledge of and sensitivity to the individual's preferences, values, and beliefs;

(C) availability to the individual for assistance or support; and

(D) advocacy for the individual's preferences, values, and beliefs.

(2) Audio-only--A synchronous interactive, two-way audio communication that uses only sound and meets the privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA). Audio-only includes the use of telephonic communication. Audio-only does not include audio-visual or in-person communication.

(3) Audio-visual--A synchronous interactive, two-way audio and video communication that conforms to privacy requirements under HIPAA. Audio-visual does not include audio-only or in-person communication.

(4) CFC services--Community First Choice services. State plan services described in 1 TAC Chapter 354, Subchapter A, Division 27 (relating to Community First Choice).

(5) Comprehensive encounter (Encounter Type A)--Contact with an individual receiving services as defined in 1 TAC §355.746 (relating to Reimbursement Methodology for Mental Retardation Service Coordination) and including comprehensive encounters funded by general revenue.

(6) Designated LIDDA--As identified in the HHSC data system, the LIDDA responsible for assisting an individual and LAR or actively involved person to access services and supports.

(7) Duration--The specified period of time during which service coordination is provided to an individual.

(8) Frequency--The minimum number of times during a specified period that an individual is to be contacted by a service coordinator in person based on the individual's need for contacts as determined by person-centered planning.

(9) Follow-up encounter (Encounter Type B)--Contact with the individual receiving services as defined in 1 TAC §355.746 (relating to Reimbursement Methodology for Mental Retardation Service Coordination) and including follow-up encounters funded by general revenue.

(10) General revenue--Funds appropriated by the Texas Legislature for use by HHSC.

(11) HCS Program--The Home and Community-based Services Program. A program operated by HHSC as authorized by the Centers for Medicare & Medicaid Services in accordance with §1915(c) of the Social Security Act.

(12) HHSC--The Texas Health and Human Services Commission.

(13) ICF/IID--Intermediate care facility for individuals with an intellectual disability or related conditions. An ICF/IID is a facility in which ICF/IID Program services are provided.

(14) ICF/IID level-of-care--A level-of-care described in §261.238 of this title (relating to ICF/MR Level of Care I Criteria) or §261.239 of this title (relating to ICF/MR Level of Care VIII Criteria).

(15) ICF/IID Program-- A program operated by HHSC that provides Medicaid-funded residential services to individuals with an intellectual disability or related conditions, as described in §1905(d) of the Social Security Act.

(16) ICF/MR--ICF/IID.

(17) In-person (or in person)--Within the physical presence of another person. In-person or in person does not include audio-visual or audio-only communication.

(18) Individual--A person who is or is believed to be a member of the LIDDA priority population.

(19) Institution--One of the following:

(A) an ICF/IID;

(B) a nursing facility licensed or subject to being licensed in accordance with THSC Chapter 242;

(C) an assisted living facility licensed or subject to being licensed in accordance with THSC Chapter 247;

(D) a child-care operation subject to regulation by HHSC as a general residential operation under Texas Human Resources Code Chapter 42;

(E) a hospital;

(F) an inpatient chemical dependency treatment facility;

(G) a mental health facility;

(H) a facility operated by the Texas Workforce Commission; or

(I) a prison.

(20) Institution for mental diseases--As defined in §273.3 of this title (relating to Definitions), a hospital of more than 16 beds that is primarily engaged in providing psychiatric diagnosis, treatment, and care of individuals with mental diseases, including medical care, nursing care, and related services.

(21) Intellectual disability--Consistent with THSC §591.003, significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(22) LAR--Legally authorized representative. A person authorized by law to act on behalf of an individual with regard to a matter described in this chapter, and who may be a parent, guardian, or managing conservator of a child; or the guardian of an adult.

(23) LIDDA--Local intellectual and developmental disability authority. An entity designated by the executive commissioner of HHSC in accordance with THSC §533A.035.

(24) LIDDA priority population--A population as defined in §304.102 of this title (relating to Definitions).

(25) Local service area--A geographic area composed of one or more Texas counties defining the population that may receive services from a LIDDA.

(26) MCO--Managed care organization. This term has the meaning set forth in Texas Government Code §543A.0001.

(27) Permanency planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(28) Person-centered planning--A philosophy and planning process that empowers an individual and, on the individual's behalf, an LAR or actively involved person, to direct the development of a plan of services and supports.

(29) Plan of services and supports--A written plan that:

(A) describes the desired outcomes identified by an individual, or an LAR or actively involved person on behalf of the individual;

(B) describes the services and supports to be provided to the individual, including service coordination;

(C) identifies the frequency of in-person contacts to be provided to the individual, in accordance with §331.11(h) of this chapter (relating to Designated LIDDA's Responsibilities); and

(D) identifies the duration of service coordination to be provided to the individual.

(30) Related condition--Consistent with 42 CFR §435.1010, a severe and chronic disability that:

(A) is attributable to:

(i) cerebral palsy or epilepsy; or

(ii) any other condition, other than mental illness, found to be closely related to an intellectual disability because the condition results in impairment of general intellectual functioning or adaptive behavior similar to that of people with intellectual disabilities, and requires treatment or services similar to those required for people with intellectual disabilities;

(B) is manifested before the person reaches 22 years of age;

(C) is likely to continue indefinitely; and

(D) results in substantial functional limitation in three or more of the following areas of major life activity:

(i) self-care;

(ii) understanding and use of language;

(iii) learning;

(iv) mobility;

(v) self-direction; and

(vi) capacity for independent living.

(31) Relative--A person related to the individual within the fourth degree of consanguinity or within the second degree of affinity.

(32) Service coordination--Through both comprehensive and follow-up encounters, service coordination consists of assistance in accessing medical, social, educational, and other appropriate services and supports that will help an individual achieve a quality of life and community participation acceptable to the individual, or individual and LAR as follows:

(A) crisis prevention and management--linking and assisting the individual and LAR or actively involved person to secure services and supports that will enable them to prevent or manage a crisis;

(B) monitoring--ensuring that the individual receives needed services, evaluating the effectiveness and adequacy of services, and determining if identified outcomes are meeting the individual's needs and desires as indicated by the individual and LAR or actively involved person;

(C) assessment--identifying the individual's needs and the services and supports that address those needs as they relate to the nature of the individual's presenting problem and disability; and

(D) service planning and coordination--identifying, arranging, advocating, collaborating with other agencies, and linking for the delivery of outcome-focused services and supports that address the individual's needs and desires as indicated by the individual and LAR or actively involved person.

(33) State hospital--Consistent with THSC §552.0011, a hospital operated by HHSC primarily to provide inpatient care and treatment for individuals with mental illness.

(34) State supported living center--A state-supported and structured residential facility that is an ICF/IID operated by HHSC to provide persons with an intellectual disability a variety of services, including medical treatment, specialized therapy, and training in the acquisition of personal, social, and vocational skills, but does not include a community-based facility owned by HHSC.

(35) Subaverage general intellectual functioning--Consistent with THSC §591.003, measured intelligence on standardized general intelligence tests of two or more standard deviations (not including standard error of measurement adjustments) below the age-group mean for the tests used.

(36) TAC--Texas Administrative Code. A compilation of state agency rules published by the Texas Secretary of State in accordance with Texas Government Code Chapter 2002, Subchapter C.

(37) THSC--Texas Health and Safety Code.

(38) TxHmL Program--The Texas Home Living Program. A program operated by HHSC as authorized by the Centers for Medicare & Medicaid Services in accordance with §1915(c) of the Social Security Act.

§331.11. Designated LIDDA's Responsibilities.

(a) If a LIDDA determines an individual is eligible for and desires service coordination, the LIDDA must develop a plan of services and supports for the individual using person-centered planning that is consistent with the HHSC Person-Centered Planning Guidelines.

(1) For the TxHmL and HCS Programs, the person-directed plan (PDP), as defined in §262.3 and §263.3 of this title (relating to Definitions), respectively, qualifies as a plan of services and supports.

(2) For an individual receiving CFC services through an MCO, a completed HHSC Community First Choice Assessment form qualifies as a plan of services and supports.

(b) A LIDDA must ensure that service coordination:

(1) is provided to an individual in accordance with the individual's plan of services and supports; and

(2) is not provided by an employee who is a relative of the individual or who has the same residence as the individual.

(c) A LIDDA may provide crisis prevention and management to an individual without having first identified the need for such services in the individual's plan of services and supports.

(d) A LIDDA must complete the HHSC Service Coordination Assessment form:

(1) at intake to determine an individual's eligibility;

(2) when the individual's needs change and the frequency of in-person contact in the individual's plan of services and supports needs to be revised; and

(3) at least annually.

(e) The HHSC Service Coordination Assessment must:

(1) be completed by the service coordinator with the individual, or individual and LAR when applicable; and

(2) identify the frequency of in-person service coordination contact.

(f) A LIDDA must ensure that a service coordinator revises an individual's plan of services and supports:

(1) if:

(A) the individual's needs change; or

(B) the individual, LAR or actively involved person, service provider, or other person provides relevant information indicating the appropriateness of revising the plan; and

(2) using person-centered planning that is consistent with the HHSC Person-Centered Planning Guidelines.

(g) Service coordination, during both comprehensive and follow-up encounters, must involve at least one of the four elements listed in the definition of "service coordination" in §331.5 of this chapter (relating to Definitions).

(h) A LIDDA must ensure that a service coordinator meets with an individual in person in accordance with one of the following, whichever is the most frequent:

(1) at least once every 90 days or more frequently in accordance with the HHSC Service Coordination Assessment form; or

(2) for the minimum number of in-person contacts required by:

(A) rules or other requirements of the program or services in which the individual is enrolled; or

(B) a contract between HHSC and the LIDDA.

(i) A service coordinator may meet with an individual via audio-only or audio-visual communication for a comprehensive encounter:

(1) in a month when minimum in-person contact in accordance with subsection (h) of this section is not required; and

(2) if, before the service coordinator conducts the meeting using audio-only or audio-visual communication, the service coordinator obtains:

(A) the written consent of the individual or LAR, which may only be effective for up to a year; or

(B) the individual's or LAR's verbal consent, which may only be effective for that encounter, and documents the verbal consent in the individual's record.

(j) If a service coordinator does not obtain an individual's or LAR's written or verbal consent required by subsection (i)(2)(A) or (B) of this section respectively, the service coordinator must:

(1) document the individual's or LAR's refusal to receive a comprehensive encounter via audio-only or audio-visual communication in the individual's record; and

(2) conduct the comprehensive encounter in person.

(k) If a service coordinator identifies a concern with implementation of the plan of services and supports, the LIDDA must:

(1) communicate the concern to the entity providing the services and supports; and

(2) ensure the entity makes attempts to resolve the concern.

(l) In addition to the requirements in this chapter, a LIDDA must ensure service coordination is provided to individuals enrolled in the TxHmL Program in accordance with:

(1) Chapter 262 of this title (relating to Texas Home Living (TxHmL) Program and Community First Choice (CFC)); and

(2) Chapter 264 of this title (relating to Consumer Directed Services Option)).

(m) In addition to the requirements in this chapter, a LIDDA must ensure service coordination is provided to individuals enrolled in the HCS Program in accordance with:

(1) Chapter 263 of this title (relating to Home and Community-based Services (HCS) Program and Community First Choice (CFC)); and

(2) Chapter 264 of this title.

§331.19. Employee Training.

(a) A LIDDA must ensure that the following employees complete the training as described in subsection (b) of this section:

(1) an employee who provides service coordination; and

(2) an employee who directly supervises or oversees the provision of service coordination.

(b) A LIDDA employee described in subsection (a) of this section must:

(1) within the first 90 days of the employee's date of hire, complete training that addresses:

(A) appropriate LIDDA policies, procedures, and standards;

(B) the LIDDA's performance contract requirements regarding service coordination;

(C) plan of services and supports development and implementation;

(D) person-centered planning consistent with the HHSC Person-Centered Planning Guidelines;

(E) permanency planning;

(F) crisis prevention and management, monitoring, assessment, and service planning and coordination;

(G) community support services, including Medicaid state plan services such as CFC services;

(H) advocacy for individuals; and

(I) additional trainings designated by HHSC; and

(2) within the first six months of the employee's date of hire, complete a comprehensive non-introductory person-centered service planning training approved by HHSC, unless HHSC grants an extension of the six-month timeframe.

(c) A LIDDA must document the training completed in accordance with this section in the personnel record of each employee providing, supervising, or overseeing service coordination.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on September 29, 2025.

TRD-202503485

Karen Ray

Chief Counsel

Health and Human Services Commission

Effective date: October 19, 2025

Proposal publication date: May 16, 2025

For further information, please call: (512) 438-5609