TX HHS Form H2060-A. Addendum to Form H2060

Form H2060-A is an official Texas Health and Human Services Commission (HHSC) document used as an addendum to Form H2060. It is designed to identify and authorize additional Personal Assistance Services (PAS) hours that were not fully captured in the original needs assessment. This form plays a critical role in ensuring that Medicaid applicants or members receive the level of in-home support necessary to remain safely in the community.

Purpose of Form H2060-A

The primary purpose of Form H2060-A is to document additional PAS minutes that were not identified through the standard assessment tools, such as the Needs Assessment Questionnaire and Task/Hour Guide. It allows the interdisciplinary team to justify extra service time required to prevent institutional placement and to accurately calculate authorized service hours.

This form is not a standalone document. It must always be used in conjunction with Form H2060 and other Individual Service Plan (ISP) documents.

Who Must Use This Form

Form H2060-A is typically completed by a service coordinator as part of the Medicaid service planning process. It applies to applicants or members receiving community-based services where PAS hours need adjustment.

• Medicaid applicants or members receiving Personal Assistance Services
• Service coordinators responsible for ISP development
• Interdisciplinary team members involved in care planning

When This Form Is Required

This form is required only in specific situations. It should not be completed routinely for every assessment.

• When additional PAS tasks are identified after Form H2060 is completed
• When protective supervision or extended therapy time is required
• When delegated nursing tasks or health maintenance activities increase PAS needs
• When Consumer Directed Services (CDS) nursing tasks are performed by an attendant

If no additional PAS hours are needed, Section II should be marked “Not Applicable,” and the form proceeds directly to PAS time totals.

Section-by-Section Explanation

Section I – Identifying Information

This section captures basic identifying details, including the applicant or member’s name, Medicaid ID number, Social Security number, ISP effective date, and service coordinator information. Accuracy here is essential, as these identifiers link the addendum to the correct service plan.

Section II – Additional PAS Hours

This section documents PAS tasks not identified on Form H2060. Each task is broken down by minutes per day, days per week, and total minutes per week. Examples include protective supervision, extension of therapy, delegated nursing tasks, and other additional PAS services.

The total PAS minutes per week calculated here feed directly into the authorization process.

Section III – Comments

This section allows for brief explanatory notes. Space is intentionally limited, so comments should be concise and focused on clarifying why additional PAS hours are required.

Section IV – PAS Time Totals

This is the most technical section of the form. It combines PAS minutes from Form H2060 and Form H2060-A, converts minutes to hours, adjusts for Aid and Attendance (A&A) and Third Party Resources (TPR), and calculates the final authorized hours per year. Errors in this section can directly affect service authorization.

Section V – Certification

This section confirms that the interdisciplinary team agrees the services are necessary to prevent nursing facility placement. Signatures are documented on Form H1700-3 rather than directly on this form.

Legal and Regulatory Context

Form H2060-A is governed by Texas Medicaid policy and HHSC rules related to community-based services. The form supports compliance with federal Medicaid requirements that mandate services be medically necessary, properly documented, and cost-effective alternatives to institutional care.

Without this addendum, HHSC may not authorize additional PAS hours, even if the need exists.

Practical Tips for Completing the Form

• Ensure all identifying information matches Form H2060 exactly.
• Only document tasks that were truly not identified in the original assessment.
• Double-check all time calculations, especially rounding rules.
• Clearly note any A&A or third-party resources to avoid over-authorization.
• Keep comments brief but specific.

Common Mistakes to Avoid

• Using the form when no additional PAS hours are needed
• Mathematical errors in time calculations
• Failing to adjust for A&A or TPR hours
• Submitting the form without linking it to Form H1700-1 and H1700-3

Real-Life Use Examples

• A member’s condition worsens mid-year, requiring additional protective supervision hours.
• New delegated nursing tasks are added that were not part of the original assessment.
• A CDS attendant begins performing health maintenance activities not previously authorized.

Documents Commonly Submitted With This Form

• Form H2060 (Personal Assistance Services Assessment)
• Form H1700-1 (Individual Service Plan)
• Form H1700-3 (Signature Page)
• Supporting clinical or assessment documentation

Frequently Asked Questions

Is Form H2060-A required for every PAS assessment?

No. It is only required when additional PAS hours are identified beyond those documented on Form H2060.

Who completes Form H2060-A?

The service coordinator completes the form with input from the interdisciplinary team.

Can this form be used without Form H2060?

No. It is an addendum and must be used together with Form H2060.

Does this form authorize services by itself?

No. Authorization occurs through the Individual Service Plan after calculations are transferred.

What happens if this form is completed incorrectly?

Errors can delay authorization or result in incorrect service hours.

Micro-FAQ

• Purpose: To document additional PAS hours not captured on Form H2060.
• Who files: Service coordinators.
• When used: When extra PAS needs are identified.
• Attachments: Form H2060, ISP documents.
• Submitted to: HHSC through the ISP process.

Related Forms

• Form H2060 – Needs Assessment Questionnaire and Task/Hour Guide
• Form H1700-1 – Individual Service Plan
• Form H1700-3 – ISP Signature Page

Form Details

• Form Name: Addendum to Form H2060
• Form Number: H2060-A
• Issuing Agency: Texas Health and Human Services Commission
• Region: Texas
• Revision Date: August 2021