TX HHS Form 8493. Notification Regarding a Death in HCS. TxHmL and DBMD Programs

Form 8493 is an official incident notification document used by Texas Medicaid waiver program providers to report the death of an individual receiving services. It applies to the Home and Community-based Services (HCS), Texas Home Living (TxHmL), and Deaf Blind with Multiple Disabilities (DBMD) programs.

The form ensures that the Texas Health and Human Services Commission (HHSC) and the local intellectual and developmental disability authority (LIDDA) are promptly informed so that required reviews, risk assessments, and follow-up actions can occur.

Purpose of Form 8493

The purpose of Form 8493 is to provide HHSC with timely, structured information about the circumstances surrounding a participant’s death. This includes basic identifying details, program information, the type and place of death, and whether additional investigations or documentation may be required.

The form also triggers internal review processes and determines what supporting records must be submitted for clinical and risk assessment.

When This Form Must Be Submitted

Form 8493 must be submitted when a program provider becomes aware of the death of an individual enrolled in HCS, TxHmL, or DBMD services.

• For HCS and TxHmL: by the end of the next business day after the death or after the provider learns of the death
• For DBMD: within 24 hours after the provider learns of the death

The form is not required for individuals who are not actively enrolled in these programs or when the provider has no service relationship with the individual at the time of death.

Who Is Responsible for Completing the Form

The form is completed by the program provider. This is usually done by administrative leadership, compliance staff, or designated incident management personnel.

The provider is responsible for ensuring the form is submitted to HHSC through fax or the Salesforce provider portal and that the local service coordinator is also notified within required timelines.

Explanation of Key Sections

Provider and Contact Information

This section identifies the provider organization, contract number, program type, and contact details. Accurate information ensures HHSC can follow up quickly if clarification is needed.

Individual and Program Identification

This section records the individual’s name, CARE ID, program enrollment (HCS, TxHmL, or DBMD), and admission date. Errors here can delay review or result in mismatched records.

Death Details

Providers must document the date of death, when the provider was notified, the place of death, type of residence, and whether the death was expected or unexpected. If known, the cause of death and autopsy status are also included.

Medical and Service History

This section captures recent hospitalizations, hospice involvement, and other relevant clinical context that may affect risk assessment.

Description of Events

Providers give a brief narrative describing the circumstances surrounding the death. This summary should be factual and concise.

Supporting Documentation Requirements

The form outlines extensive documentation that must be submitted within three business days, depending on the program. These records allow HHSC risk assessment staff to evaluate care, services, and compliance.

Practical Tips for Completing Form 8493

• Submit the form as soon as timelines allow; do not wait for all records to be collected.
• Use factual, objective language in the description of events.
• Double-check program selection to ensure correct requirements apply.
• Track deadlines for follow-up document submission.
• Keep copies of everything submitted for audit purposes.

Common Mistakes to Avoid

• Missing the required submission deadline
• Providing incomplete or inaccurate dates
• Leaving the description of events blank or overly vague
• Failing to submit required supporting documentation on time
• Not notifying the service coordinator in parallel

Legal and Regulatory Context

Form 8493 is required under Texas Administrative Code provisions governing HCS, TxHmL, and DBMD programs. These rules mandate prompt reporting of deaths to ensure participant protection, oversight, and program accountability.

Failure to comply with reporting requirements may result in increased monitoring, corrective actions, or enforcement measures against the provider.

Real-Life Situations Where This Form Is Used

• An individual receiving HCS services passes away at home and the provider learns of the death from family.
• A TxHmL participant dies during a hospital stay and the provider is notified the same day.
• A DBMD participant enrolled in assisted living dies unexpectedly and requires rapid notification.

Documents Commonly Submitted with This Form

• Most recent Person-Directed Plan or Individual Program Plan
• Medication administration records
• Nursing assessments and nursing notes
• Physician orders and lab work
• Residential or habilitation service notes
• Hospice or hospital records, if applicable
• Death certificate, if available

Frequently Asked Questions

How quickly must Form 8493 be submitted?

By the next business day for HCS and TxHmL, and within 24 hours for DBMD.

Can the form be submitted before all records are gathered?

Yes, the initial notification must be submitted first.

Who receives the form?

HHSC and the local service coordinator.

Is fax submission still allowed?

Yes, fax or the Salesforce provider portal may be used.

What happens after submission?

HHSC conducts a risk assessment and may request additional records.

Does every death require supporting documentation?

Yes, documentation requirements apply based on the program.

Related Forms

• Incident Management and Reporting Forms
• Person-Directed Plan (PDP)
• Individual Program Plan (IPP)
• Provider Investigation Documentation

Form Details

• Form Name: Notification Regarding a Death in HCS, TxHmL, and DBMD Programs
• Form Number: 8493
• Programs: HCS, Texas Home Living, DBMD
• State: Texas
• Revision Date: September 2023