Making a Referral for Evaluation and Treatment Services
This information is provided so that all DFPS caseworkers get the same information about how to set up a new client for services at AHC, no matter the time of day.
The documents we will need are DFPS Form 2054 (Authorization) and DFPS Form 2036 (Referral). We cannot begin seeing your client under this contract without BOTH of these forms. (Please note, the full name of the second form listed above is K-903-2036. It is a counseling referral form. This is not to be confused with Form 2063, which is a type of release.)
For ALL services, we need a 2036 referral
- 2036 MUST have the name of the person you are referring
- 2036 has places to fill in for both parent and child, even if you are referring only the parent or only the child. When you include a name on the form just for information purposes but will not be referring that person, please include additional detail so that it is clear which family members you expect to receive our services)
- 2036 MUST have your name and contact information.
- 2036 MUST have your supervisor’s name and contact information.
- If there is space for additional contact information, please provide it when possible–program director, admin tech, assistant, transporter–anyone else who might need to have information.
- 2036 MUST be signed.
For ALL services, we need a 2054 authorization, but the authorization is different for different types of services.
Please follow these instructions carefully. If you encounter a problem, contact our staff and we will try to help you, but remember that we do not have access to or training on IMPACT. The best place to go for help with creating an authorization to refer someone to us is to the Contracts Department within DFPS. You can contact our staff to ask who our current contract manager is, but any contract manager should be able to help you.
For ALL services:
- Form 2054 you will create in IMPACT. We do not have access to IMPACT so we need to you send us the 2054 as a pdf file.
- 2054 MUST be signed by both you and the approver (usually your supervisor). This is a requirement of our contract with DFPS, so we can’t provide services without that.
- SEE BELOW FOR INFORMATION ABOUT DIFFERENT TYPES OF 2054s FOR DIFFERENT TYPES OF SERVICES.
For individual counseling services:
In addition to the 2036 as described above, for individual counseling services:
- 2054 MUST have at least four units of psychosocial on it–but we prefer you do the following:
- 4 units of 86U (psychosocial in person)
- 4 units of 91U (psychosocial virtually)
- 20 units of 86C (in person individual counseling services sessions)
- 20 units of 91C (virtual individual counseling services session)
We need all those units for EVERY family member who will be seen.
Rest assured, we will not use units outside what you request or outside what the contract dictates. The reason we need units of 86U AND 92U is because clients sometimes suddenly need to switch from in person to virtual due to transportation issues, illness, child care issues, other health concerns, etc. When this happens, if we have only units for “in person” services, we have to completely cancel the appointment, which is not beneficial to the client. Likewise, clients sometimes need to switch from virtual to in person for a variety of reasons (internet has been shut off, phone service is not working, poor connections, difficulty using technology, lack of privacy at a location, difficulty staying focused, etc.). When you provide BOTH types of units, your clients will benefit (and we won’t have to contact you to request changes, allowing you to perform other work that benefits your clients as well.)
For FAMILY (including COUPLES) counseling services:
- 2054 MUST have at least four units of psychosocial on it unless these were already provided as part of another referral to US (we cannot rely on a psychosocial created by another agency; these are the terms of our contract with DFPS).
- 4 units of 86U (psychosocial in person)
- 4 units of 91U (psychosocial virtually)
- 20 units of 86F (in person family counseling services sessions)
- 20 units of 91F (virtual family counseling services sessions)
For this type of counseling, we need ALL the units under the eldest family member who will be present–NOT units for each family member.
As above, however, please make sure to provide both in person and virtual units, for all the same reasons.
For COURT SERVICES (regardless of who is requesting we appear):
- 2054 MUST have at least EIGHT units for 86H, Court Services. This ensures that the therapist will be paid for their time. Please note:
- This is one of few areas where DFPS authorizes therapists to be paid why they WAIT to testify as well time spent testifying
- In addition to creating a 2054 form, you must also SIGN Form 2057, which is documentation that court took place and that the therapist attended. The therapist will have this form ready and will ask you to sign it immediately when they are released. This is not a form that you can “do later” as it is required to document the time that the therapist was present. The form must be signed regardless of whether you or the client agrees with the therapist’s testimony. The therapist is being paid for their time spent.
- You do NOT need to have the therapist served with a subpoena.
- A subpoena is not a substitute for a 2054 authorization.
- We will not appear without a properly executed 2054. Remember–a 2054 must be SIGNED by the caseworker creating it AND by an approver (usually a supervisor. Do not wait until the day before you want a therapist to appear to begin the procedure. The process goes much more smoothly when you add units of Court Services as soon as you begin to suspect that you may need the therapist to testify. This is also a courtesy to other clients–you would not want your client’s therapist to cancel your client’s appointment with short or no notice, so please don’t do that to other clients and other caseworkers–give us significant advanced notice so that we can plan our schedules.
DIAGNOSTIC CONSULATION
A Diagnostic Consultation is used to pay a therapist for their time when you want the therapist to attend a meeting or participate in a family group conference, Circle of Support, or other similar service.
- Create a 2054 with 8 units of 81H, Diagnostic Consultation
- Don’t worry if the meeting is expected to be only an hour or two. We will only bill for the hours the therapist attends, and DFPS has a system for documenting the hours.
- Give the therapist sufficient notice. Creating a 2054 does not automatically clear the therapist’s schedule.
SERVICES FOR CHILDREN IN FOSTER CARE
- This contract DOES NOT COVER treatment services for children in foster care
- If a child is placed in foster care, their services MUST be paid through Superior Medicaid.
- We have several therapists who are in network with Superior Medicaid, but we MUST know that the child is in foster care.
- If someone in your unit tells you that it’s okay as long as IMPACT lets you create the 2054, this is incorrect. The DFPS Contracts Department will still reject the claims, and the child client may have to change therapists. Avoid this situation and tell us up front:
- if the child is in foster care
- if the child is likely to be placed in foster care
- if the child’s family member or kinship caregiver is pursuing becoming licensed/verified as a Texas Foster Family.
- If this happens, we can still help them family, but we need to know rather than be surprised.
- If someone in your unit tells you that it’s okay as long as IMPACT lets you create the 2054, this is incorrect. The DFPS Contracts Department will still reject the claims, and the child client may have to change therapists. Avoid this situation and tell us up front:
88K (Services in Client Homes)
- This service was population before telehealth was acceptable to the State.
- We have not had a request for units of 88K since before the pandemic in 2020.
- We do not currently have therapists available to go to client homes.