Guides for IDD group-home providers.
Straight answers to the questions agency owners, nurses, and supervisors ask about eMARs, EHRs, progress notes, and state surveys. Each guide leads with the answer and lists the official sources behind it.
What EHR and eMAR works for group homes and IDD providers?
The EHR and eMAR that work for IDD group homes are built for direct support professionals, not hospital nurses. Look for a phone app DSPs will use mid-shift, an eMAR that fits delegated med passes, notes tied to plan goals, incident follow-up, your state forms, and a clear answer on billing and EVV. Sereniq is built for exactly this.
What is an eMAR?
An eMAR (electronic medication administration record) is a digital record of every medication a person is prescribed and every dose given, refused, or missed. It replaces the paper MAR binder. In IDD group homes, a good eMAR fits DSPs passing meds under nurse delegation and records home visits, hospital stays, and PRN doses.
How to prepare for an HHSC survey
Prepare for an HHSC survey by keeping every record survey-ready all year, because surveys can be unannounced. HHSC Long-Term Care Regulation reviews a sample of individual records, staff and training files, medication records, and the homes, and interviews individuals and staff. Fix gaps in MARs, plans, progress notes, and training before they are found.
How to write IDD progress notes
A good IDD progress note says what the DSP saw and did, in plain objective words, and ties it to a goal in the person's plan. Include the date and time, the goal worked on, what support was given, how the person responded, and anything that changed. Write it during or right after the shift.
What is the HCS program in Texas?
The Home and Community-based Services (HCS) program is a Texas Medicaid waiver that pays for services and supports so people with an intellectual disability or a related condition can live in the community instead of an institution. HHSC runs it, local IDD authorities (LIDDAs) manage the interest list and service coordination, and contracted providers deliver the services.
How do you complete HHSC Form 4119?
HHSC Form 4119 is the Service Delivery Log for HCS Residential Support Services (RSS) and Supervised Living (SL). Staff who delivered the service fill one form per individual, one column per billable day (up to seven), initial the activities they did, sign, and finish it within 14 calendar days of the service.
Can DSPs pass medications in Texas?
Yes, with conditions. In Texas HCS and TxHmL, a paid unlicensed DSP may give oral, topical, and metered dose inhaler medications for a stable or predictable condition once an RN has assessed the individual and the DSP is trained. Other medications and nursing tasks need RN delegation under Texas Board of Nursing rules.
What is ISS in Texas?
Individualized Skills and Socialization (ISS) is the Texas Medicaid waiver day service that replaced day habilitation in the HCS, TxHmL, and DBMD programs in 2023. ISS helps individuals build the skills to live in and take part in their community, and it is delivered on-site at a licensed location, off-site in the community, or in-home.
How to choose EHR software for a Texas HCS or IDD provider agency
Choose the EHR your DSPs will use on a shift and your office can take into an HHSC survey. Sereniq fits Texas HCS, HCBS, Host Home, and ISS agencies of any size: a DSP app on iOS and Android, an eMAR where refusals alert nurses, goal-linked notes, incidents, HHSC form prints, AI a human reviews, and onboarding with training.
Texas Medicaid waiver programs for people with IDD
Texas has four Medicaid waiver programs for people with an intellectual or developmental disability: HCS, TxHmL, CLASS, and DBMD. Each pays for services in the community instead of an institution. HHSC runs them, providers deliver the services, and Community First Choice adds attendant and habilitation services on top of all four.
What is a LIDDA in Texas?
A LIDDA, or Local Intellectual and Developmental Disability Authority, is the local point of entry for publicly funded IDD services in Texas. It determines eligibility, manages the HCS and TxHmL interest lists for its area, enrolls people in HCS, TxHmL, and ICF/IID, and provides service coordination, including the person-directed plan.
How do you become an HCS provider (or host home provider) in Texas?
To become an HCS program provider in Texas, enroll in Texas Medicaid through TMHP, complete HHSC's Provider Applicant Training and pass the competency exam, then apply to HHSC for a contract. HHSC awards a provisional contract, and HHSC surveys the agency within 120 days after its first individual is enrolled. Host home providers work through a program provider instead.
HCS billing documentation: what records support an HCS claim in Texas?
Every HCS claim in Texas must be backed by written, legible documentation. Under HHSC's HCS Program Billing Requirements, the service must be authorized on the IPC and supported by a service log written by the person who delivered it, within 14 calendar days. HHSC recoups payment for any claim a fiscal compliance review cannot verify.
HCS slot releases are paused: what should Texas HCS providers do?
HHSC stopped releasing HCS interest list reduction slots starting in May 2026 because HCS funding for the biennium cannot support more releases, and it has not given a date to resume. While the pause lasts, providers should protect what they have: well-supported individuals, steady staff, defensible billing, and survey-ready records.
How do you report abuse, neglect, and incidents in Texas HCS?
In a Texas HCS program, anyone who knows or suspects abuse, neglect, or exploitation of an individual must report it to the Texas Abuse Hotline at 1-800-252-5400 or txabusehotline.org immediately, and HCS rules set the outer limit at one hour. HHSC Provider Investigations investigates. If someone is in immediate danger, call 911 first.
How do you start a group home in Texas?
In Texas, "group home" is not one license. A group home for people with an intellectual disability is often an HCS residence, run by a program provider that holds an HHSC contract and passes HHSC certification. Housing four or more unrelated people with personal care outside HCS points to an assisted living license, and children's homes are licensed separately.
What are the HCS host home requirements in Texas?
An HCS host home/companion care provider is an adult who works for an HCS program provider and lives with the individual. The home must be owned or leased by the host home provider or the individual, never the program provider, and no more than three people there can receive the service. The program provider inspects the home every quarter.
ICAP and level of need: how Texas HCS assigns a LON
The ICAP (Inventory for Client and Agency Planning) is the assessment HHSC uses to set a level of need (LON) for individuals in HCS. The ICAP service level goes on the ID/RC Assessment, Form 8578, and converts to LON 1, 5, 8, or 6. Behavior or nursing needs can raise it, and LON 9 covers life-threatening behavior.
HCS rates in Texas for 2026: how they work and where to find them
HCS payment rates in Texas are set by the HHSC Provider Finance Department and vary by service and, for residential, host home, and ISS services, by level of need. The table in effect as of September 2026 took effect Sept. 1, 2025. It lists residential support at $164.46 per day for LON 1 and $341.83 for LON 9.