What is Protective Supervision?

Protective Supervision is a service approved under the Home and Community Services Waiver (HCS) as part of Supported Home Living (SHL).

Community First Choice(CFC) does NOT in the service called Protective Supervision. However, Community First Choice (CFC) does allow for limited supervision for reminding and monitoring related to activities of daily living, such as bathing or eating, that are not solely for the purpose of protective supervision. The CFC supervision option is not widely understood or used in Texas.

A quick search on the Star Plus websites shows that Protective Supervision is a service that is offered in the Star Plus Waiver.

Protective Supervision is a supportive service for people who, due to a physical or mental disability need to be observed at times during the day or night to protect them from injuries, hazards or accidents. Historically, an HCS provider was paid to observe and monitor a child or adult with an intellectual or developmental disability when the person needs intermittently or ongoing monitoring or assistance, in order to remain safely in the community and their own home or family home when. It was provided in the HCS waiver until CFC services became available in 2014. Since then, it is very difficult to justify and impossible to bill.

The need for Protective Supervision must be identified through person centered planning and be included in a person’s individual service plan. Supported Home Living and CFC may both be included in a person’s service plan, but billing guidelines inadvertently omitted allowable billing for protective services within Supported Home Living. Families and advocates have waited for more than a year for resolution of this billing issue.

Currently the state of Texas (HHSC/DADS) DOES NOT have
  • a way to bill for Protective Supervision in HCS under Supported Home Living
  • an updated assessment tool that identifies the need for CFC supervision related to activities of daily living or Protective Supervision as billable HCS service.
  • an updated CFC instruction guide that includes reminding and monitoring across all areas of functioning, depending on each individual’s needs or Protective Supervision as billable HCS service.
Susan Murphree, Senior Policy Specialist at Disability Rights Texas, in Austin, is inquiring about the status of these and other actions related to Protective Supervision. CPSH will be assisting Susan to encourage more transparency about Protective Supervision. It is imperative that HHSC/DADs clarify this service so that more consumers may apply for and use it.

You may be able to apply for increase supervision through CFC at this time, only when it is related to an activity of daily living, while awaiting resolution of the HCS Protective Supervision issue. Work with your service coordinator and service planning team, including the provider, to determine whether CFC supervision is needed. To receive appropriate CFC supervision here are some tips.
  • Include language regarding "reminding" and "monitoring" in both the Person Centered Plan and the CFC assessment as appropriate to the individual’s actual need<./li>
  • Include in the plan and assessment over night needs and why. For example: fall risk when getting up to go to the bathroom, risk to flooding if the sink faucet isn't shut, risk of burning skin with water too hot....
  • If need is intermittent (not respite) need to state how often and why.
  • Track the specific "reminding" and "monitoring" of a family member or aide for 3 months, to show the frequency. This will help justify the need for CFC supervision.
Reference: 2015 California Info on Protective Supervision

If your child is receiving HCS Medicaid Waiver Services, contact your Service Coordinator to discuss CFC supervision or Protective Supervision. A person’s person centered plan and individual service plan can be updated as needed, not just annually.

If your child is not receiving HCS Medicaid Waiver Services, contact your Star+Plus Managed Care Organization.