Form 1735-SP "Service Provision Requirements Addendum - Star+plus Home and Community Based Services (Hcbs) Program" - Texas

What Is Form 1735-SP?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2021;
  • The latest edition provided by the Texas Health and Human Services;
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  • Fill out the form in our online filing application.

Download a fillable version of Form 1735-SP by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

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Form 1735-SP
September 2021-E
Consumer Directed Services (CDS)
Service Provision Requirements Addendum
STAR+PLUS Home and Community Based Services (HCBS) Program
Services Available Under the CDS Option
Personal Assistance Services (PAS): Personal assistance services include assistance to members with the performance
of the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) necessary based on the member’s
service plan to maintain the home in a clean, sanitary and safe environment.
• Respite Services: In-home and out-of-home respite services are available on an emergency or short-term basis to relieve
those persons normally providing unpaid care for a member who is unable to care for himself or herself.
• Skilled Nursing: Nursing services can be skilled or specialized in nature and do not replace a member's acute care benefit.
Nursing services are assessment, planning and interventions provided by a person licensed to engage in professional
nursing or vocational nursing in Texas, or licensed in a state that has adopted the Nurse Licensure Compact.
• Physical Therapy (PT): Physical therapy is defined as specialized techniques for evaluation and treatment related to
functions of the neuro-musculoskeletal systems provided by a licensed physical therapist or a licensed physical therapy
assistant directly supervised by a licensed physical therapist. Physical therapy is the evaluation, examination and utilization
of exercises, rehabilitative procedures, massage, manipulations and physical agents (such as mechanical devices, heat,
cold, air, light, water, electricity and sound) in the aid of diagnosis or treatment.
• Occupational Therapy (OT): Occupational therapy consists of interventions and procedures to promote or enhance safety
and performance in activities of daily living, instrumental activities of daily living, education, work, play, leisure and social
participation. It is provided by a licensed occupational therapist or a certified occupational therapy assistant directly
supervised by a licensed occupational therapist.
• Speech Therapy (ST): Speech therapy is defined as evaluation, diagnosis and treatment of impairments, disorders or
deficiencies related to a member's cognition, communication, voice and swallowing. It is provided by a speech-language
pathologist or a licensed associate in speech-language pathology under the direction of a licensed speech-language
pathologist.
• Cognitive Rehabilitation Therapy (CRT): Cognitive rehabilitation therapy is a service that assists a member in learning or
relearning cognitive skills that have been lost or altered because of damage to brain cells/chemistry in order to enable the
member to compensate for the lost cognitive functions, including reinforcing, strengthening or reestablishing previously
learned patterns of behavior or establishing new patterns of cognitive activity or compensatory mechanisms for impaired
neurological systems. Services are provided in accordance with the plan of care developed by the assessor.
• Employment Assistance: Employment assistance helps the individual locate competitive employment in the community.
Employment assistance includes:
• identifying a member's employment preferences, job skills, and requirements for a work setting and work conditions;
• locating prospective employers that offer employment compatible with a member's identified preferences, skills and
requirements; and
• contacting a prospective employer on behalf of a member and negotiating the member's employment.
An individual cannot receive employment assistance at the same time as respite or supported employment.
• Supported Employment: Supported employment is provided in order to sustain competitive employment for a member
who, because of a disability, requires intensive ongoing support to be self-employed, work from home or perform in a work
setting at which individuals without disabilities are employed. Individuals receiving supported employment earn at least
minimum wage (if not self-employed). Supported employment includes employment adaptations, supervision and training
related to a member's assessed needs. A member cannot receive supported employment at the same time as respite, or
employment assistance.
I have read and understand the services .....................................................................................
Initials
Who Cannot Be the Employee
• Primary caregiver(s)
• Employer
• Employer’s spouse
Form 1735-SP
September 2021-E
Consumer Directed Services (CDS)
Service Provision Requirements Addendum
STAR+PLUS Home and Community Based Services (HCBS) Program
Services Available Under the CDS Option
Personal Assistance Services (PAS): Personal assistance services include assistance to members with the performance
of the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) necessary based on the member’s
service plan to maintain the home in a clean, sanitary and safe environment.
• Respite Services: In-home and out-of-home respite services are available on an emergency or short-term basis to relieve
those persons normally providing unpaid care for a member who is unable to care for himself or herself.
• Skilled Nursing: Nursing services can be skilled or specialized in nature and do not replace a member's acute care benefit.
Nursing services are assessment, planning and interventions provided by a person licensed to engage in professional
nursing or vocational nursing in Texas, or licensed in a state that has adopted the Nurse Licensure Compact.
• Physical Therapy (PT): Physical therapy is defined as specialized techniques for evaluation and treatment related to
functions of the neuro-musculoskeletal systems provided by a licensed physical therapist or a licensed physical therapy
assistant directly supervised by a licensed physical therapist. Physical therapy is the evaluation, examination and utilization
of exercises, rehabilitative procedures, massage, manipulations and physical agents (such as mechanical devices, heat,
cold, air, light, water, electricity and sound) in the aid of diagnosis or treatment.
• Occupational Therapy (OT): Occupational therapy consists of interventions and procedures to promote or enhance safety
and performance in activities of daily living, instrumental activities of daily living, education, work, play, leisure and social
participation. It is provided by a licensed occupational therapist or a certified occupational therapy assistant directly
supervised by a licensed occupational therapist.
• Speech Therapy (ST): Speech therapy is defined as evaluation, diagnosis and treatment of impairments, disorders or
deficiencies related to a member's cognition, communication, voice and swallowing. It is provided by a speech-language
pathologist or a licensed associate in speech-language pathology under the direction of a licensed speech-language
pathologist.
• Cognitive Rehabilitation Therapy (CRT): Cognitive rehabilitation therapy is a service that assists a member in learning or
relearning cognitive skills that have been lost or altered because of damage to brain cells/chemistry in order to enable the
member to compensate for the lost cognitive functions, including reinforcing, strengthening or reestablishing previously
learned patterns of behavior or establishing new patterns of cognitive activity or compensatory mechanisms for impaired
neurological systems. Services are provided in accordance with the plan of care developed by the assessor.
• Employment Assistance: Employment assistance helps the individual locate competitive employment in the community.
Employment assistance includes:
• identifying a member's employment preferences, job skills, and requirements for a work setting and work conditions;
• locating prospective employers that offer employment compatible with a member's identified preferences, skills and
requirements; and
• contacting a prospective employer on behalf of a member and negotiating the member's employment.
An individual cannot receive employment assistance at the same time as respite or supported employment.
• Supported Employment: Supported employment is provided in order to sustain competitive employment for a member
who, because of a disability, requires intensive ongoing support to be self-employed, work from home or perform in a work
setting at which individuals without disabilities are employed. Individuals receiving supported employment earn at least
minimum wage (if not self-employed). Supported employment includes employment adaptations, supervision and training
related to a member's assessed needs. A member cannot receive supported employment at the same time as respite, or
employment assistance.
I have read and understand the services .....................................................................................
Initials
Who Cannot Be the Employee
• Primary caregiver(s)
• Employer
• Employer’s spouse
Form 1735-SP
Page 2 / 09-2021-E
• Member receiving services
• Member’s spouse
• Designated representative (DR), if you have one
• DR’s spouse
• Legally authorized representative (LAR) — if under age 18, the member's parent, foster parent, managing conservator,
stepparent or court-appointed guardian; if age 18 or over, the member's court-appointed guardian
• LAR's spouse
I have read and agree not to hire any of the above as a service provider ....................................
Initials
Service Delivery Documentation
• Time sheet; or
• Electronic Visit Verification (EVV) record.
I have read and agree to follow the service delivery documentation requirements......................
Initials
Service Backup Plans
• A backup plan is required for each service to be delivered through the CDS option that the member’s service planning team
has determined to be critical to the health and welfare of the member.
• The CDS employer is responsible for developing a backup plan (Form 1740, Service Backup Plan). The service coordinator
must approve the backup plan.
• The service coordinator will review the backup plan on an annual basis and may request a revised backup plan if it is found
ineffective.
I have read and agree to the service backup plan requirements ..................................................
Initials
Other Special Requirements
• The employee may only perform tasks for the member receiving services, not for other family members. For example, your
respite provider cannot cook dinner for everyone in the household.
• The member must utilize services monthly to maintain eligibility for the STAR+PLUS HCBS program.
• The member or the member's primary caregiver may change the service schedule for respite services if the change:
• does not exceed the member's cost ceiling per individual service plan (ISP) year;
• only uses hours not used in a previous month; and
• does not increase the member's total monthly hours by more than three times the monthly hours authorized.
• The same employee cannot provide more than 16 hours of services within a 24-hour period.
• Services cannot be delivered outside the state of Texas.
• A registered nurse (RN) must sign Form 1747, Acknowledgement of Nursing Requirements, and conform to the Texas
Board of Nursing (BON) Nursing Practice Act before providing services and must keep required documentation in the
member’s home. A licensed vocation nurse must sign Form 1747-LVN, Licensed Vocational Nurse (LVN) Supervision, and
conform to the BON Nursing Practice Act before providing services and must keep required documentation in the member’s
home.
• Employee bonuses must be included in the CDS employer budget and must be accrued from hours that the employee has
worked. Hours not used during the service plan year cannot be converted to a bonus.
• The employer cannot submit a time sheet to the financial management services agency (FMSA) for time the employee
worked while the member was in the hospital or any other institutional setting.
• The employer must keep a copy of all CDS employer forms for each employee, except the criminal history reports, in the
home.
I have read and agree to follow the special requirements ............................................................
Initials
Form 1735-SP
Page 3 / 09-2021-E
Employee Qualifications
• be age 18 or older;
• have a high school diploma or a certificate recognized by a state as the equivalent of a high school diploma; or
• documentation of a proficiency evaluation of the employee’s experience and competence to perform job tasks, including
an ability to provide the services needed by the member, as demonstrated through a written competency-based
assessment;
• at least three personal references from people not related by blood that evidence the person’s ability to provide a safe
and healthy environment for the member;
• have a valid Social Security number, regardless of residence, and provide appropriate documentation required for the
completion of Form I-9, Employment Eligibility Verification, for verification of citizenship and immigrant status as
required by the federal government;
• have no criminal convictions listed by state law that prohibit employment in a health care setting;
• have no conviction of Medicaid fraud or abuse;
• not be on the Employee Misconduct Registry or Nurse Aide Registry list;
• maintain a current driver’s license and insurance if transporting the member;
• be able and willing to meet the needs of the member receiving services and, with training, be able to follow direction
from the employer and the DR;
• have reliable transportation to the member's home within the service schedule;
• meet and maintain provider qualifications as required by the program and/or by state or federal law;
• not be denied a nursing license under Chapter 301 or 302, Occupations Code; and
• not issued a nursing license under Chapter 301, Occupation Code, that is revoked or suspended.
For nurses and therapists: Must meet and maintain professional licensure qualifications as required by the program and/or
state or federal law.
If providing supported employment or employment assistance: The employee must satisfy one of the following combinations
of education and experience:
Option 1: Have —
• a bachelor's degree in rehabilitation, business, marketing or a related human services field; and
• six months of paid or unpaid experience providing services to people with disabilities.
Option 2: Have —
• an associate's degree in rehabilitation, business, marketing or a related human services field; and
• one year of paid or unpaid experience providing services to people with disabilities.
Option 3: Have —
• a high school diploma or general equivalency diploma (GED), and
• two years of paid or unpaid experience providing services to people with disabilities.
For cognitive rehabilitation therapy: The service provider must be:
• a psychologist licensed by the Texas State Board of Examiners of Psychologists under Title 3 of the Texas
Occupations Code, Subtitle H, Chapter 501, Psychologists;
• a speech-language pathologist licensed under Title 3 of the Texas Occupations Code, Subtitle G, Chapter 401,
Speech-Language Pathologists and Audiologists; or
• an occupational therapist licensed under Title 3 of the Texas Occupations Code, Subtitle H, Chapter 454,
Occupational Therapists.
I have read and agree to hire providers who meet the qualifications ...........................................
Initials
Form 1735-SP
Page 4 / 09-2021-E
Training Requirements for All Service Providers
• Before providing direct services to a member, the service provider must complete specific training provided by the CDS
employer.
• The CDS employer must document all initial and ongoing training activities on Form 1732, Management and Training of
Service Provider, and send Form 1732 to the FMSA within 30 calendar days after hiring the service provider and every year
within 30 calendar days after the service provider’s hire anniversary date.
If the employer chooses to use the CDS exemption from nursing delegation (Form 1733, Employer and Employee
Acknowledgement of Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services),
the employer provides training for any nursing tasks listed on Form 1733.
I have read and agree to ensure providers meet the training requirements .................................
Initials
The service coordinator, FMSA, MCO or Texas Health and Human Services Commission utilization review staff can talk
with the member or member’s LAR about the services available through the CDS option and ask to review all CDS
employer forms.
I have read, understand and agree to comply with the STAR+PLUS HCBS program requirements. If I do not follow these requirements,
I understand that I can be reported to the appropriate authorities for Medicaid fraud.
Employer or Designated Representative Signature
Date
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