WHAT IS PRIMARY HOME CARE THROUGH TEXAS DEPARTMENT OF AGING AND DISABILITY?
What is PHC?
This program is a nontechnical, medically related personal care service provided to adults whose health problems cause them to be functionally limited in performing activities of daily living, according to a statement of medical need. PHC provider agencies also provide Family Care services. This service also is a nonskilled, nontechnical service provided to eligible clients who are functionally limited in performing daily activities.
Contracting information: 512-438-3015
Contract Oversight: Community Services Contracts Unit Manager
Eligibility information: Your local DADS office
Policy information: 512-438-3740
Regional nurses: Community Services regional contacts for your region
PHC Home and Community Support Services (HCSS) providers must be licensed as a DADS Home and Community Support Services Agency (HCSSA) with the Personal Assistance Services category of license and have a contract with DADS to provide PHC services. Rules regarding minimum standards for HCSSA can be found in Title 40 of the Texas Administrative Code (TAC) as follows:
Texas Administrative Code , Title 40, Part 1, Chapter 97 Licensing Standards for Home and Community Support Services Agencies(link is external)
Services provided in Primary Home Care Program can be managed by the state or participants can choose to manage their care providers themselves. These two types of service delivery models are referred to as Service Responsibility Option (SRO) or Consumer Directed Services (CDS), respectively. The Consumer Direct model is becoming increasingly popular with participants because they are given the flexibility to hire and manage their care providers and certain family members can be hired to provide attendant care services. Typically, spouses and legal guardians are excluded from being hired but the adult children of aging parents and ex-spouses can be paid caregivers. This type of program is also referred to as Cash and Counseling or Participant Direction.
It is worth noting that this is a Medicaid program, meaning participants must be eligible for Medicaid and that Texas also has a very similar program for non-Medicaid eligible residents called the Community Attendant Services (CAS) Program.
To be eligible for the PHC Program, Texas residents must be 21+ years old and require assistance to perform at least one of the activities of daily living such as bathing, grooming, eating or toileting. Their functional limitation must result from a medical condition and must be documented by a medical professional.
The financial eligibility criteria for PHC are the same as for regular Texas Medicaid. In 2017, a single aged (65 and over) person applying must have income below $735 per month and the value of their assets cannot be greater than $2,000. If the applicant owns a home, this does not include any home equity that they might have in their primary residence. However, if they do not live in their home and it is clear they will not be returning for medical reasons and they do not have a spouse that lives in the home, then the home is valued in their assets. An additional exception to the exempt home rule is when the value of their home equity exceeds $560,000.
It is worth noting that although the home is exempted from consideration during eligibility, it is still possible that the state will place a lien on the home to recover part of the value of the services during their recipient's lifetime.
If two individuals, a married couple, are both seeking Medicaid simultaneously, their combined monthly income cannot be greater than $1103 and countable resources are limited to a value of $3,000.
Qualifying for Medicaid When Over the Limits It is possible to qualify for Medicaid in Texas when one exceeds the financial limits by re-allocation of income and assets into trusts and exempt resources. To do this, it is recommended that a Medicaid planning professional provide guidance as these processes can be complicated and carry financial risks.
Benefits and Services
Participants in the PHC Program can be approved for up to 50 hours / week of assistance however the average individual receives approximately 16 hours / week. Services can include assistance with any of the following:
Personal care assistance with bathing, grooming, dressing, eating, medication administration and transferring
Assistance with the instrumental activities of daily living such as shopping, housekeeping, laundry and meal preparation
Assistance with transportation for medical appointments
Contracting to Provide Services
To be eligible to provide services and receive reimbursement for these services, a provider agency must meet certain eligibility criteria. Rules regarding minimum eligibility requirements for contracting can be found in Title 40 of the Texas Administrative Code (TAC) as follows:
TAC, Title 40, Part 1, Chapter 47: Contracting to Provide Primary Home Care(link is external)
Texas Administrative Code, Title 40, Part 1, Chapter 49: Contracting For Community Care Services(link is external)
For more information about DADS provider enrollment process and requirements, please click here.
An individual or provider agency must complete an application to provide services in the Community Services programs. Once you have met the minimum eligibility criteria, you may review the required application documents at:
Form 5830, Application Packet Checklist, State Office Enrolled
At Altruist Home Health Care, we wish for our clients to be well-informed before partnering or partaking in any of our firm’s services. We hope your experience will be better once you know who we are, have more realistic ideals and goals about working with us, as well as understand what we are focused on doing for you and our community. If there are any other questions or concerns you may be having, please contact us at (214)328-8600
WE HAVE TWO GREAT LOCATIONS TO SERVE YOU
6301 Gaston Avenue, Suite 610
Dallas, TX 75214
Phone: (214) 328-8600
5402 Wesley Street, Suite D
Greenville, TX 75402
Phone: (903) 259-6345