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Twogether Newsletter
Issue 6.16.22

Happy CNA Day from Twogether Consulting! Each year, the United States honors nursing assistants on the Thursday of the second full week of June. Otherwise known as National Career Nursing Assistants’ Day, CNA Day kicks off CNA Week, a seven-day celebration of all the amazing nursing assistants and nursing aides across the country and the world.

So, to all the CNAs out there, thank you! And for everyone else, please join us in showing some much-deserved appreciation for the many essential tasks that CNAs handle in the healthcare workplace.

Katheryn Ware is her son Kylen’s daytime personal care aide three days a week as well as nights. The 27-year-old has quadriplegic cerebral palsy, prAmid Caregiver Shortage

'The system is in ruins': Minnesotans with disabilities feel left behind amid workforce shortage
MINNEAPOLIS — Before the pandemic, Caleb George-Guidry lived in a group home with a circle of friends and staff who understood his spirited personality. He also attended a day support center where he enjoyed a wide range of activities, from painting to yoga, designed for adults like him with significant disabilities.
Now, more than two years later, George-Guidry’s life has been turned upside down. Because of severe staffing shortages, the 31-year-old last fall was forced to move out of his group home of the past 12 years and into a new house with strangers who did not comprehend his way of communication. Then George-Guidry’s day center in St. Paul abruptly suspended his services after nine years — leaving him isolated and depressed. Today, George-Guidry, who was born with a rare disorder that affects his physical and cognitive development, spends much of his time watching videos and playing games in the common space of the house. “Most of us are moving past this pandemic, but there’s a whole community of people with disabilities who have not been able to move on,” said Matt Guidry, his father, who lives in Minneapolis. “It could and should be different.” Read More
A Note From Julie
I know it has been a difficult last few months for HCS/TxHmL providers, with all the new changes that have taken place and there are more to come. Please send us feedback on how it is going with the new switch from CARE to TMHP system. I have received many calls with questions, concerns, and complaints. If you have specific questions about billing/ claims problems in TMHP please feel free to email them to me so we can also find solutions. Please check for TMHP updates on our website. We need your feedback so we can try to help follow up on HCS/TxHmL provider issues and needs. Thanks.
You can also email us comments at
Twogether Newsletter Sponsors
Pegue-Dennis, CPA P.C. 
Office 1: 469-708-4272 

June Client Update Newsletter

The last thing you may want to do during the summer is start thinking about your 2022 tax return! The best way to lower your tax bill for next year, however, is to start looking for tax cutting strategies as soon as possible. In this month’s newsletter, read about some tax planning tips to help you lower your 2022 taxes. Also read about tax implications if you have a side hustle, money management tips for couples, and how to make your child’s summer break a tax break! Please feel free to forward the information to someone who may be interested in a topic and call with any questions you may have.

Start Your Tax Planning NOW!

Keeping your taxes as low as possible requires paying attention to your financial situation throughout the year. Here are some tips for getting a head start on tax planning for your 2022 return:

  • Start Your Tax Planning NOW imageCheck your paycheck withholdings. Now is a good time to check your tax withholdings to make sure you haven’t been paying too much or too little. The IRS has an online tool that will help you calculate how much your current withholdings match what your final tax bill will be. Visit
    Action step: To change how much is withheld from your paycheck in taxes, fill out a new Form W-4 and give it to your employer.
  • Defer earnings. You could potentially cut your tax liability by deferring your 2022 income to a future year via contributions to a retirement account. For 2022, the 401(k) contribution limit is $20,500 ($27,000 if 50 or older); $6,000 for both a traditional and Roth IRA ($7,000 if 50 and older); or $14,000 for a SIMPLE IRA ($17,000 if 50 and older).
    Action step: Consider an automatic transfer from either your paycheck or checking account to your retirement account so you won’t have to think about manually making a transfer each month.
  • Plan withdrawals from retirement accounts to be tax efficient. Your retirement accounts could span multiple account types, such as traditional retirement accounts, Roth accounts, and taxable accounts like brokerage or savings accounts. Because of this you should plan for your withdrawals to be as tax efficient as possible.
    Action step: One way to structure withdrawals is to pull from taxable accounts first, and leave Roth account withdrawals for last. Another approach would be to structure proportional withdrawals from all retirement accounts that would lead to a more predictable tax bill each year.
  • Net capital gains with capital losses. If you have appreciated investments you’re thinking about selling, take a look through the rest of your portfolio to see if you have other assets that you could sell for a loss and use to offset your gains. Using the tax strategy of tax-loss harvesting, you may be able to take advantage of stocks that have underperformed.
    Action step: Make an appointment with your broker to look over your portfolio to see if there are any securities you may want to sell by the end of 2022.

Tax planning can potentially result in a lower bill from the IRS if you start taking action now. Please call if you have questions about your tax situation for 2022. Read More

Guardian Pharmacy of Dallas-Fort Worth


For people with I/DD, taking medications as prescribed is essential to managing chronic conditions, minimizing adverse effects, and improving their overall health. Many often have a tough time with medication adherence whether it is one prescription or more, which is most often the case. In fact, 80% of individuals with I/DD are prescribed five or more medications; more than 60% have 10 or more1. Juggling numerous medications can be problematic for these individuals, many of whom have trouble performing even the basic activities of daily living and face cognitive, physical, and communication challenges. While the residents rely on direct support professionals, nurses, medication technicians and other employees for medication help, staff who serve them often face challenges ensuring compliance on a daily basis. This complication, coupled with the fact that residents have varying levels of functionality and medication needs, adds to the complexity, stress and demands of the job. These are just a few factors that have created a staff retention problem. Additional key challenges include:
• Staff Training: Constant turnover can hinder an organization’s ability to properly train staff. While every ICF and supported living provider understands that well-educated staff members make fewer mistakes, most cannot afford to offer training to new employees on an ongoing basis. If the organization is not engaged with an LTC pharmacy that provides this training, they often have to outsource it, which can be expensive.
• Poor Pharmacy Support & Communication: I/DD organizations have unique needs that should involve constant interaction and industry expertise from a pharmacy partner. This level of commitment requires 24/7 pharmacy support and communication. Without it, members of the I/DD staff can be left in situations where they feel overwhelmed and uncertain of the right decision. Sadly, too many organizations experience insufficient assistance from their pharmacy, with some not knowing the appropriate pharmacy contact for every situation, including the best person to answer daily questions and provide after-hours and emergency services.

• Lack of Access to Newer Technologies: Technology can play a tremendous role in the accuracy and efficiency of medication management, but with so many program options in the market, organizations may have a hard time researching and understanding which systems are best to meet their immediate and future needs. Additionally, many are still using paper MARs, increasing the workload of the organization’s staff and the risk of human transcription error.

If you work with a pharmacy that specializes in medication compliance, you can minimize medication errors and billing complaints, leading to greater individual and staff happiness. Selecting the LTC pharmacy partner that shares the same level of enthusiasm and empathy you have for the residents you serve is equally as important. Build a relationship with a pharmacy that views meeting the needs of individuals with I/DD the same way you do – as a privilege and source of pride.
With Guardian Pharmacy Texas, you get the best of both worlds – Experience and Compassion. 

 If you have any questions, please see contact information below.
Contact Kevin Kirkpatrick 
Office: 817-633-6688 | Cell: 972-742-3003
Guardian Pharmacy Texas


**If you sign up for services with Guardian and mention "Twogether Consulting" to Kevin Kirkpatrick, you could receive up to 6 months of "paper"
MARS (Medication Administration Review Sheets) for FREE!

We are looking for new sponsors/
advertisers for the newsletters!

Please contact Meghan for more information!
Ryan is our new contact for Texas
Twogether Trainings


Webinar: “Common Nursing Issues Resulting
In Survey Violations” (HCS/TxHmL)
Date: June 23, 2022
Time: 10:00 AM-12:00PM
Q&A: Noon-12:15pm
Cost: $65

For:  Program Managers, Administrators, Case Managers/Care Coordinators, Nursing Staff
Presenter:  Julie Blacklock & Guest RN Consultant

You will receive a confirmation email and handout as well as a link to register with “Gotowebinar” to attend the session, once we receive payment.  Please click on your registration link right away to receive reminders for the session!
– HCS/TxHmL Interpretive Guidance Booklet (Review of Specific Nursing Sections)
–Examples of Some of the Most Current & Common Violations Related To Nursing
–Prevention Ideas & Discussion
-(POC’s) Plan of Correction Ideas & Discussion
-Important Policies, Procedure & Training To Develop & Implement
and much more


Webinar: “Pop-Up” Live Training Nursing Series:
HCS (Dallas, Tx) Limited Seating 

**We have extended Early Registration! Don't Wait!
Cost $325/person- Closes June 18th, 2022**
Twogether Consulting is happy to announce that we have a limited invite we are sending out to HCS/TxHmL Providers who would like to attend our Nurse Training Series.  We will be presenting this training session live at Sheraton Hotel & Conference Center, in Dallas Tx.  “A Place of Grace” has been kind enough to sponsor the location and invite other HCS/TxHmL Providers the chance for Nurses, Program Managers, and/or QA staff the opportunity to attend our first “live” nurse training series in quite some time.  Space is very limited.  So please contact us as soon as possible if you are interested in having any of your staff attend.  

Below are some specifics about the training including, the exact location in Dallas where the training will take place, as well as some restaurants and hotels in the area, and the agenda.   Please contact Meghan Jones for registration ASAP, with limited seating.

Dates:  June 29th and 30th, 2022.
Times:  Day 1:  9:30AM-4:30PM, Day 2:  9AM-4PM 
Cost:  $350/ per person (for the 2 days total).   You may pay via PayPal invoice with PayPal, Credit or Debit Card, or our business Venmo account and also by check
Handouts:  Training Manuals will be provided as well. 
Location:  Sheraton Hotel By The Galleria (Conference Room)  Dallas, TX
4801 Lyndon B Johnson Fwy, Dallas, TX 75244
We will be posting a link in the near future, for a discounted rate for those of you wanting to reserve a hotel room at the Sheraton or you may ask when you call the hotel.  Please let them know you are attending a training in their conference room with Twogether Consulting as the presenters if you call. Hotel Ph:  (972) 661-3600    

Topics: Day 1
“Expectations of The Nurse”  Part I
-Intro To HCS & TxHmL Waivers
-Rules & Regs
-Roles & Responsibilities: RN Vs. LVN
-Developing The Nursing IP
-Health Status Monitoring, Updating Nursing Care Plan,
-Med Errors, Incident Reports, Delays In Service and F/U 
“Expectations of The Nurse” Part II
-RN Delegations & Other Determinations

Topics: Day 2
New Interpretive Guidance Booklet: Discussion of Survey Expectations Concerning Nursing
“Completion & Description of  The CNA: Form 8584” (RN’s)

Upcoming Conferences 
Alternate text

Dismantling Systemic Barriers: Reenvisioning Equity and Inclusion

AAIDD has taken an innovative approach for this year's conference and will be holding one conference in two venues: in person and virtual. This will give you an opportunity to attend in-person (June 13-16), virtually (June 27-29), or both. 

Register Here

Reconnect with colleagues and friends at these networking events.

Don't forget to connect with speakers and colleagues in the live chat during the virtual component!


Student and Early Career Reception (Virtual) 
Tuesday, June 28
6:30 - 7:30 pm 


Save the Date:
Quality in Long-Term Care Conference

HHS, along with The University of Texas Steve Hicks School of Social Work, will host the 
2022 Quality in Long-Term Care Conference in-person.
Renaissance Austin Hotel
Aug. 11–12
The conference is free to attend. Online registration opens Wednesday, June 15.
This year’s theme, “Resilient, Responsive and Ready,” was selected due to Texan’s:
  • Resiliency.
  • Ability to recover quickly from the challenges of the pandemic.
  • Responsiveness to the ever-changing ways of working in the new normal in their professions and being ready for whatever comes next.
Continuing education credit for multiple disciplines will be provided for this event.
Email UT Steve Hicks School of Social Work for more information about this event.
Mark Your Calendar!
 Don't miss the opportunity to learn from experts in the field, regulators and colleagues & refresh our commitment as to why we do what we do.
 Attached please find Marketing Opportunities to include sponsorship and exhibiting. All conference-related information can also be accessed on PPAT's website at
Registration – A registration form is attached and can be completed and submitted by email to Forms can also be submitted by mail to the PPAT Office at 8711 Burnet Road, Ste. E-53, Austin, TX 78757 or faxed to 512-458-3078. Online Registration will be available soon!
Hotel Reservations - Click on the link to reserve your room:   2022PPATConfHotelReservations  
Conference Session topics will be forthcoming.
2022 Conference Registration Form  
2022 Conference Forms All
We Look Forward to Seeing You in September!


New Dates, New Location.

The only historic beachfront hotel on the Gulf Coast of Texas, The Grand Galvez, is undergoing renovation just in time to host AAIDD Texas Chapter's 46th Annual Convention!
They're bringing back the luxury and sophistication, with a nod to the original design of 1911 and a refreshed elegance throughout. Renovations include everything from guest rooms to common areas to the beautiful grounds, and provide a casual opulence sure to please. Mark your calendars for November 15 - 18, 2022 and we'll see you at the GRAND GALVEZ!

Job Postings

A Home and Community-based Services (HCS) Provider

Seeking an RN on a contract basis for an HCS Program. The RN MUST HAVE HCS EXPERIENCE. The RN will complete nursing assessments annually and as needed, medication training, delegations to unlicensed staff, special needs training, medical specific training, review medical documents, and provide triage/post hospital assessments when needed to individuals residing in the group home setting.

Primary responsibilities include:

· Nursing Assessments (annually and as needed)

· RN Delegations

· Staff Trainings

· Annual Meetings

· Face-to-face assessment/post hospital visits

· New med/1st dose

· On-call

· Immediate follow-up following physician’s appointments with nursing assessment revision if necessary

· Medication monitoring Medication reconciliation/monthly cycle meds

Must have HCS experience.

$40 per billable hour

Job Types: Full-time, Part-time, Contract

Salary: $40.00 per hour

Kate Wills
President/Executive Director
A Home and Community-based Services (HCS) Provider
Office:  281-482-3163
Cell:  713-670-4673
Fax 1:  281-482-3162 
Fax 2: 713-481-6206
Do you know an awesome college-aged person that would be a great fit to work at
camp and with our campers? SEND THEM OUR WAY!
Perks of camp include, but aren't limited to...
Competitive Salary
Internship Credits
Room/Board for 10-weeks
Unlimited S'mores
Epic Adventures
Lasting Memories
Job Skills
Camper Smiles
Fun and Laughter
Lifelong Friendships 

1 Care Premier Services LLC
Registered Nurse (RN) Home and
Community-Based Services (HCS) Program
Houston, TX 77060

RN position available!

For more information, click on this Indeed link

Mark I Residential HCS

Mark Henson-CEO/Owner

Ph:  512-789-4079

Location:  Austin, Texas

Starting Pay:  $50,000

Position: Case Manager (Need immediately, approximately 20 client caseload/primarily
medically fragile individuals in Group Homes)

Job Qualifications:

Previous experience in case management working with individuals with intellectual and developmental disabilities, preferred, but will consider other experience with IDD services.  i.e.. HCS, TxHmL or ICF program or other DD programs. Degree in Social Services or Psychology required if you do not have experience. Must be comfortable working with individuals with high medical needs. Contact us for more information.

Contact Meghan if you would like
to feature a job posting in our next newsletter!
Twogether Updates

June 12th, 2022 Potential Long-Term Care Remittance and Status Report Delays Due to the Home and Community-Based Services American Rescue Plan Act Provider Retention Payments (Add-On) for personal attendant and nursing services, rates are being updated. Refer to Information Letter No. 2022-30 for additional information. From TMHP "Because of the Home and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) provider retention payments (add-on) for personal attendant and more

June 12th, 2022 ICF COVID-19 Vaccination Reporting Emergency Rules Expired June 6!! Emergency rules for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions that require COVID-19 vaccination reporting expired June 6. This means that effective June 7, ICFs no longer have to report COVID-19 vaccination data for staff and individuals to HHSC. The following rules expired June 6: 26 TAC §551.48 – ICF/IID Provider COVID-19 Vaccination Data more

June 12th, 2022 EVV Portal and Training Updates Texas Medicaid and Healthcare Partnership updated the Electronic Visit Verification Portal and related training materials on June 9. There are also two new visit rejection codes related to EVV system transfers. Refer to the EVV Portal and Training Updates notice on TMHP’s EVV webpage for more information. Email questions to TMHP. June 6th, 2022 EVV Policy Handbook Revision and Training Updates The Electronic Visit Verification Policy Handbook more

June 6th, 2022 Register for June 8 HCBS ARPA Stakeholder Update Webinar HCBS providers are urged to attend this HCBS ARPA Stakeholder Update Webinar. HHSC will provide updates on the Texas Home and Community Based Services Spending Plan authorized under Section 9817 of the American Rescue Plan Act HCBS ARPA Stakeholder Update June 8 2:30 p.m. – 3:30 p.m. Register for the HCBS ARPA Stakeholder Update webinar.

June 3rd, 2022 Guidance related to Emergency Preparedness- Exercise Exemption based on A Facility's Activation of their Emergency Plan *** Revised to provide additional guidance and clarifications due to the ongoing COVID-19 public health emergency (PHE) REVISED 05.26.2022 *** Memorandum Summary • Emergency Preparedness Training and Testing Program Exemption -CMS regulations for Emergency Preparedness (EP) require facilities to conduct exercises to test the facility’s EP plan to ensure that more

Based on the many phone calls, emails and contacts through our social media pages concerning Job Positions Desired and Job Openings with HCS providers, I have decided to use our "Updates" page to provide a place where both those persons desiring a position with an HCS Provider and those Posting a Job Position can find each other! We will not neccesarily be posting the job description or information on this page directly.  If you contact Meghan Jones at and let her more

TMHP & HHSC Response to Common Migration Issues:   Click on link below TMHP Migration Complaints-HHSC Responses-060222   You can contact TMHP directly to submit your questions/ issues/requests for assistance using the  template below and using the following email address: -Subject: HCS/TxHmL Question/Issue (and a short description of the issue or question) -Point of Contact (POC) Name: -National Provider Identifier (NPI)/Contract Number: -POC Phone Number: -POC...

read more

Status of HCS Rates as of June 3rd  2022 Provider Rate Updates for HCS and TxHmL Providers In early May, HHSC identified missing or incorrect rate keys for some Home and Community-based Services and Texas Home Living providers. On May 11–12, HHSC completed updates to rate keys for these HCS and TxHmL providers based on rates published on the Provider Finance website. Read the full alert. After confirming rates with Provider Finance and paid claims on the R&S Report, contact the TMHP LTC...

read more

Last updated on 6/1/2022 HCS and TxHmL Waiver Programs: Trending Issue Support Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs), and financial management services agencies (FMSAs) that bill on behalf of consumer-directed services (CDS) have been submitting claims and forms to Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers...

read more

June 2nd, 2022 Don't Forget! American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention Payments Attestation and Initial Reporting Initial report is due by July 1, 2022. The Texas Health and Human Services Commission (HHSC) implements American Rescue Plan Act (ARPA) Home and Community-Based Services (HCBS) Provider Retention payments. HHSC is providing funds to agency providers and consumer-directed services employers to support recruitment and retention...

read more

Here is the TMHP page that you can check for updates on fixes, errors discovered and other updates on TMHP issues in HCS. Not sure everything will be sent in provider alerts on our normal Sunday emails we get from HHSC.  Sounds like they won't, so check periodically. Here is the main page if you have any issues and you can search for HCS LTC issues...

Helpful Resources
Texas Health and Human Services
Blue Gradient

Opportunity for Community Input on the 2022 Revised
Texas Promoting Independence Plan

HHSC Office of Disability Services Coordination (ODSC) is leading the development for the 2022 Revised Texas Promoting Independence Plan, as required by Senate Bill 367, 77th Legislature, Regular Session, 2011, and Executive Order RP-13. This transition aligns with ODSC’s cross-disability focus, value of stakeholder engagement, and mission to improve outcomes for people with disabilities through long-term solutions across the HHS system.

The vision is to develop a two-year strategic plan that capitalizes on the momentum from previous plans and focuses on a path that supports successful community living through targeted goals and prioritized strategies.

Community input is welcome on what targeted goals and prioritized strategies are important to include in the 2022 Texas Promoting Independence Plan. Email input to

ODSC is in the planning stage of hosting a summit in early August 2022 as another opportunity for community input. More details will be released once finalized.   

Email comments and questions to HHSC ODSC.

ARPA Funding is Available for Staff Training

The 2021 American Rescue Plan Act (ARPA) has afforded states the opportunity to invest additional funding to address staff training and credentialing.  IntellectAbility is helping some providers with this process.

IntellectAbility offers a variety of training that may be appropriate for ARPA funding including Person-Centered Thinking Training and Services
The Fatal Five eLearn series, and additional eLearn courses.

Download Here

Download this free brochure to find out which Person-Centered Thinking tools and training are the best fit for your organization.

To find out more or receive a customized package of training services 

tailored to your organization's needs, please reach out to Grace at 

727-285-4764 or

Contact us:
Twogether Consulting
P.O. Box 90426 Austin, TX 78709

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