Form 2060 Mc PDF Details

The 2060-MC form stands at the confluence of meticulous planning and the delivery of personalized care within the Texas Department of Aging and Disability Services, an essential component of the broader STAR+PLUS Waiver program designed in August 2011. As an addendum to the foundational Form 2060, it specifically caters to individuals seeking additional Personal Assistance Services (PAS) hours that were not initially identified. The careful structuring of the form reflects an understanding of the nuanced needs of applicants/members, starting from basic identifying information to the meticulous calculation of PAS hours needed versus those already granted. Through updates, it accommodates changes over time, ensuring that services adapt to evolving needs. Distinguished sections demand detailed inputs on minutes per week for additional PAS hours, methodical calculations for total service hours, and adjustments for any funding received from Veterans Affairs Aid and Attendance (A&A) along with Third Party Resources (TPR). Critical to the form's integrity is the certification by interdisciplinary team members, validating that the additional services are indeed necessary to prevent institutionalization and are suited to the member's community-based living needs. As such, the 2060-MC mirrors the commitment to deliver sufficient and customized support, fostering the well-being and independence of each individual it serves.

QuestionAnswer
Form NameForm 2060 Mc
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesCDS, Interdisciplinary, 2060-MC, h2060

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Texas Department of Aging

Form 2060-MC

and Disability Services

August 2011-E

1915(c) STAR+PLUS Waiver

Addendum to Form 2060

I. Identifying Information

1. Applicant/Member Name

2. Medicaid No.

3. UPDATE 1 – Date Completed

4. UPDATE 1 – ISP Date

5. Service Coordinator's Name

6. SSN

7. UPDATE 2 – Date Completed

8. UPDATE 1 – ISP Date

II. Addition PAS Hours Not Identified on Form 2060

 

Not Applicable (Skip to Section IV)

A.

 

B.

C.

D.

 

 

 

Number of Minutes

X

Number of Days

= Total Minutes

 

Applicable as Follows

Comments

 

Per Day

 

Per Week

Per Week

 

 

 

 

 

 

 

 

 

1.

 

Protective Supervision

 

X

 

=

 

 

 

 

 

 

 

 

 

2.

 

Extension of Therapy

 

X

 

=

 

 

 

 

 

 

 

 

 

 

 

Purchased Delegated Nursing

 

 

 

 

 

3.

 

Tasks (monthly hrs. from 3671

 

X

 

=

 

 

C, Section II, 12D divided by

 

 

 

 

 

4.33)

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

CDS and other delegated

 

X

 

=

 

 

 

nursing tasks to PAS

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Totals PAS Minutes per Week =

III.Comments (4 lines):

IV. PAS Time Totals

UPDATE 1

UPDATE 2

 

DETAILED INSTRUCTIONS

 

 

 

 

1.

1.

1.

Minutes per Week from Form 2060 – Enter the total minutes from Form 2060, if applicable, without deductions for VA A&A.

 

 

 

 

2.

2.

2.

Minutes per Week from this Form 2060-MC – Enter the total PAS minutes from this form (Section II, E. above).

 

 

 

 

3.

3.

3.

Total Minutes per Week – Add Box 1 (Minutes from 2060) to Box 2 (Minutes from 2060-MC) and enter the sum.

 

 

 

 

4.

4.

4.

Total Hours – Divide Box 3 (Total Minutes per Week) by 60, round up to the next higher half hour, and enter total.

 

 

 

 

5.

5.

5.

A&A and TPR Hours – Add any VA A&A monetary amounts (from Form 2060) to any payment from other TPR (from Form

8598). Divide total by 4.33 to determine weekly amount, then divide weekly amount by PAS hourly rate; enter total.

 

 

 

 

 

 

6.

6.

6.

Adjusted Weekly Hours – Subtract Box 5 (A&A/TPR Hours) from Box 4 (Total Hours) and enter the remainder; round up to

next higher half hour.

 

 

 

 

 

 

7.

7.

7.

Hours Authorized per Year – Multiply Box 6 (Adjusted Weekly Hours) by the number of weeks remaining in the ISP year,

round up to the next hour, and enter total. (See Form 2060 instructions if rounding to next hour exceeds limit.)

 

 

 

 

 

 

8.

8.

8.

Hours Previously Authorized this ISP Year – Enter the number of hours scheduled to have been delivered up until the

effective date of this ISP change based on the previous authorization for this ISP year, if applicable.

 

 

 

 

 

 

9.

9.

9.

Estimated Annual PAS Authorization - Enter the sum of Box 7 (Hours Authorized per Year) and Box 8 (Hours Previously

Delivered) and enter the total on Form 3671-1, Service Code 17 (round up to next hour).

 

 

 

 

 

 

V. Certification by Interdisciplinary Team Members: The waiver services identified above for this applicant/member are necessary to prevent nursing facility placement and are appropriate to meet the needs of the applicant/member in the community.

UPDATE 1

Applicant/Member/Responsible Party and Service Coordinator signatures on Form 3671-2 at initial certification and annual redetermination

Signature – Service Coordinator

 

Date

 

Signature – Applicant/Member/Responsible Party

 

Date

 

 

 

 

 

 

 

Signature – MCO Representative

 

Date

 

 

 

 

UPDATE 2

Applicant/Member/Responsible Party and MCO Service Coordinator signatures on Form 3671-2 at initial certification and annual redetermination

Signature – MCO Service Coordinator

 

Date

 

Signature – Applicant/Member/Responsible Party

 

Date

How to Edit Form 2060 Mc Online for Free

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With regards to the blanks of this specific PDF, here is what you should do:

1. You will need to complete the 12D properly, therefore be mindful while filling in the sections containing these specific blanks:

A way to fill out TPR stage 1

2. Now that the previous section is complete, it is time to put in the required details in Minutes per Week from Form, Minutes per Week from this Form, Total Minutes per Week Add Box, Total Hours Divide Box Total, AA and TPR Hours Add any VA AA, Adjusted Weekly Hours Subtract, Hours Authorized per Year, Hours Previously Authorized this, Estimated Annual PAS, V Certification by, UPDATE, and ApplicantMemberResponsible Party so you're able to move on to the next stage.

How one can prepare TPR portion 2

It's very easy to make an error while filling out the AA and TPR Hours Add any VA AA, consequently make sure that you take another look prior to deciding to send it in.

3. Completing Signature Service Coordinator, Signature MCO Representative, Date, Date, Signature, Date, UPDATE, ApplicantMemberResponsible Party, Signature MCO Service Coordinator, Date, Signature, and Date is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Filling in part 3 of TPR

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