Consumer Directed Services (CDS) Implementation Training for the Home and Community-based Services (HCS) and the Texas Home Living (TxHmL) Programs.

Consumer Directed Services (CDS) Implementation Training for the Home and Community-based Services (HCS) and the Texas Home Living (TxHmL) Programs

Consumer Directed Services
HCS & TxHmL Enrollment Screens & Individual Plan of Care CHANGES Little bit about yourself -Our focus is on the screens that have changed due to the implementation of CDS, especially the IPC We know there is a lot of information and some details may change by Day 1. Please write questions on paper and put in the box in the back. We will share questions and answers on the DADS website. If after the session you would like to ask me a question, I will be available/more than happy to answer it. We will be available before, during, and after implementation of the CDS service delivery option to provide technical assistance! There may also be other training offered to address specific identified needs (and to catch those unable to attend these sessions?).

Presentation Agenda Topic Target Audience Enrollments  MRA Staff
Revisions/Annual  Provider and MRA Staff Renewals Transfers (Adding/  Provider and MRA Staff Changing providers - PE Staff) Here is how the morning will go!

MRA ENROLLMENT STEPS (L01) - Enrollment (HCS &TxHmL) – Change
(L23) - MR/RC – No Change (L02) - IPC (HCS &TxHmL) – Change (L03) - Enrollment Checklist - No Change (L09) - Register Client Update - No Change (L05) - Provider Choice - Change -These are the steps to enroll (as pertains to Data Entry) into HCS/TxHmL. These are the enrollment steps, but we will not go through them in sequence -We are also not going over screens that have not changed, but will go through the screens that have. -We will demonstrate/show with examples, how the CDS option has changed these screens, so you - the MRA - know what you are looking at!

Consumer Demographic Update Screens…NO CHANGES!
(L11) Client Name Update (L12) Client Address Update (L10) Client Correspondent Update (L20) Guardian Information Update

Permanency Planning Review (339)
“MRA Only” Screen (If Applicable) No Changes This screen is the responsibility of the MRA This is an MRA only screen and no changes have been made.

L01 - CONSUMER ENROLLMENT

01-08-08 L01:CONSUMER ENROLLMENT: ADD/CHANGE/DELETE VC060220
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: __________ COMPONENT CODE/LOCAL CASE NUMBER: ___ / __________ PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: _ (A/ADD,C/CHANGE,D/DELETE) *** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) No change to this screen as pertains to CDS Option

01-08-08 L01:CONSUMER ENROLLMENT: ADD VC060225
NAME: CAKE, PATTY CLIENT ID: 29653 MEDICAID NUMBER: LOCAL CASE NUMBER: (Contract Number-REMOVED) COMPONENT: 030 ENROLLMENT REQUEST DATE: (MMDDYYYY) WAIVER TYPE: 1 (1-HCS,4-TXHML) PRIOR DISCHARGE FROM A MEDICAID CERTIFIED NF OR ICF-MR?: N (Y/N) ADMIT FROM:1(1=COMM,2=ICF-MR,3=STATE SCH,4=REFINANCE,5=STATE HOSP) ENTER ONE OF THE FOLLOWING: SLOT TYPE :30_ (5-OBRA, 7-MDU, 9-ICF-MR, 12-PI, 13-PI4, 16-LA/REF, 18-TXHML/WL, 20-ICFMR#2, 25-PI#3, 26-CPS-HCS, 27-SM-MED ICFMR, 29-HOPE, 30-IL REDUCTION, 31-PI-08, 32-PI5, 33-SMICF2, 34-CPS-08, 35-NF-08) SLOT TRACKING NUMBER: MFP DEMO? N (Y/N) COUNTY OF SERVICE: 227 GUARDIAN: LAST NAME : *SELF*__________ SUFFIX : ____ FIRST NAME: ____________ MIDDLE INITIAL: _ C/O : _____________________________ PHONE: ( ___ ) ___ - ____ STREET : MUDPIE__________________ CITY : AUSTIN_______________ STATE: TX ZIP CODE: ____ READY TO ADD?: Y (Y/N) ACT:_ (L00/AUTH DATA ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRN The MRA will use Their Component Code and Care ID/or Local Case Number of the consumer to get in to this screen and will not have assigned a contract number when entering this screen, therefore the contract number was removed. Money follows the person Demo has been added. If a person is coming into the waiver under this, Yes will be put as answer. If not, No will be put as an anwer.

L05 - PROVIDER CHOICE

01-08-08 L05:PROVIDER CHOICE: ADD/DEL VC060227
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: __________ COMPONENT CODE/LOCAL CASE NUMBER: 030 / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: _ (A/ADD,D/DELETE) *** PRESS ENTER *** ACT: ___ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) No proposed changes to this screen. Entering provider choice of Consumer

01-08-08 L05:PROVIDER CHOICE: ADD VC060228 NAME : CLIENT ID :
MEDICAID NUMBER: LOCAL CASE NUMBER: COMPONENT : SLOT TYPE : SLOT TRACK NO: PROGRAM PROVIDER (PRGP): COMPONENT: ___ LOCAL CASE NUMBER: __________ CONTRACT NUMBER: _________ LOCATION CODE: ____ CONSUMER DIRECTED SERVICE AGENCY (CDSA): SERVICE BEGIN DATE: (MMDDYYYY) SERVICE COUNTY: 227 TRAVIS READY TO ADD? _ (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) The changes in the screen (REQUIRED) Add ability to choose a CDSA if CDSA services have been entered on the IPC Add ability to choose a PRGP if PRGP services have been entered on the IPC Whereas prior to the changes, only allowed to add a program provider. Once provider choice has been entered, the MRA can use either the prpg provider comp or the CDSA comp.

L02 - INDIVIDUAL PLAN OF CARE (HCS)
Getting into the Individual plan of care-there are a number of items that we will talk about. Initial IPC (HCS) Will go through the L02 screens (with example) and show how the screens have changed, especially when adding the CDS option upon enrollment. We are going to look at the L02 Screen as it pertains to the enrollment into the HCS/TxHmL programs and how the choice of the CDS option will affect how these screens are completed by the MRA.

01-08-08 L02:INDIVIDUAL PLAN OF CARE VC060230
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: COMPONENT CODE/LOCAL CASE NUMBER: 030 / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: I I=INITIAL N=RENEWAL E=ERROR CORRECTION T=TRANSFER R=REVISION D=DELETE PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: (MMDDYYYY) PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) This screen is the same as was before. Enter Client ID and component code. L02/C02: Since both screens are the same

HCS 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY:INITIAL VC060232A
NAME: RANGERS, POWER A. CLCN: CLIENT ID: 37613 BEG DT: REV DT: (MMDDYYYY) END DT: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMM CASE MANAGEMENT MONS SP SPEECH/LANGUAGE ___ HRS SHL SUPPORTED HOME LIV 900 HRS OT OCCUPATIONAL THERA HRS FC HCS FOSTER CARE DAYS PT PHYSICAL THERAPY HRS SL SUPERVISED LIVING DAYS DI DIETARY HRS RSS RES SUPPORT SVC DAYS PS PSYCHOLOGY HRS NU NURSING HRS AU AUDIOLOGY HRS REH RESPITE HR HRS SW SOCIAL WORK HRS RE RESPITE DAYS DE DENTAL DOL DH DAY HABILITATION DAYS AA ADAPTIVE AIDS DOL SE SUPPORTED EMP HRS MHM MINOR HOME MODS DOL SCV SUPPORT CONSULTAT 20 HRS FMSV FMS MONTHLY FEE MO WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OHFH) READY TO ADD? Y (Y/N) ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) Because the consumer’s choice of (a) provider(s) has not been entered into CARE, the component code and local case number are those associated with the Mental Retardation Authority. If answer to “WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N)” is “Y”, the system will take you to the CDS screen. If the answer is “N” then the system will take you to the Program Provider screen. If Support Consultation or Financial Management is entered the answer to “WILL ANY SERVICES BE SELF DIRECTED?” must be ‘Y’. -Notice that abbreviations precede each service -Also notice SCV/FHSV-they are always CDS, and have a “V” behind the abbreviation. All CDS services being used with be delineated with a “V” behind the abbreviation No annual cost/cost ceiling/or calculation

01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060234A
NAME: RANGERS, POWER A CLCN: CLIENT ID: 37613 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMMB CASE MANAGEMENT 12 HRS SHLV SUPP HOME LIV HRS REHV RESPITE (HOURS) 300HRS SCV SUPPORT CONSULT 20 HRS FMSV MONTHLY FEE MO WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) CALCULATE?: N(Y/N) CDS ESTIMATED ANNUAL TOTAL: 20,121.00* READY TO ADD? Y (Y/N) ANNUAL COST: 36, COST CEILING: 78,967.75* ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) Go through this as yes to CDS/PRGP-come back for N in self directed -The units for services eligible to be self-directed will be displayed in this screen. The default option assumes that all eligible services will be self-directed. (Units are Protected, cannot change) -CDS estimate/annual cost/cost ceiling show All services that are CDS Show “V” behind the Service Abbreviation Can use “Y” “N” “N” and then B in ACT: to get back to initial entry screen (for any unit mistakes) CMMB-CDS CM rate -This is where the CDS budget is derived from

HCS 01-01-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060237A
NAME: RANGERS, POWER A. CLCN: CLIENT ID:37613 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMMA CASE MANAGEMENT MO NU NURSING HRS DH DAY HABILITATION DAYS AA ADAPTIVE AIDS DOL MHM MINOR HOME MODS DOL PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 16,315.60* READY TO CONTINUE? Y(Y/N) ANNUAL COST: 36, COST CEILING: 78,967.75* ACT:____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) CMMA-Provider CM rate For services not being self-directed the units will be displayed in this screen and cannot be changed. On the previous screen By entering “N” to “ready to add” field and entering “B” on the “ACT” field, the system will take you back to the initial IPC service entry screen. -Shows annual cost/Program Provider cost/cost ceiling------Will not calculate again on this screen -No “V” behind the service abbreviation

HCS 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060238A
NAME: RANGERS, POWER A. CLCN: CLIENT ID: 37613 PRGP:CONTRACT: COMPONENT: LOCAL CASE NUMBER: CDSA:CONTRACT: COMPONENT: LOCAL CASE NUMBER: IPC BEGIN DATE: 01/08/ REVISE DATE: 01/08/2008 END DATE: 01/06/2009 TOTAL ANNUAL COST : 36, COST CEILING: 78,967.75 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) CONTRACTED PROVIDER NAME: ______________ DATE (MMDDYYYY): ____________ IDT CERTIFICATION STATEMENT NAME DATE(MMDDYYYY) CASE MANAGER: FOREST SERVICE__________________ NURSE: NURSE JOANNE_____________ _______ CONSUMER/LEGAL REPRESENTATIVE: QUACK, DUCKIE Note: at the time the initial IPC is entered the consumer’s choice of a provider has not been entered. For this reason the program provider’s and CDSA’s contract and component and their consumer’s local case number will not be displayed.

L02 - INDIVIDUAL PLAN OF CARE (TxHmL)
Getting into the Individual plan of care-there are a number of items that we will talk about. Toward the end of this presentation we will also take a look at the proposed IPC Hard Copy’s that some of you will be filling out for HCS and TxHmL. Right now we want to spend more time on the data entry screens and how the CDS option has affected them, and will take a look at the proposed IPC’s at the end. We are going to look at the L02 Screen as it pertains to the enrollment into the HCS/TxHmL programs and how the choice of the CDS option will affect how these screens are completed by the MRA. Also going to take a look at the C02 screen as CM/Program Provider (completing Annuals and Revisions) as it also has changes to how the screens will be completed, most notable when choosing the CDS option. Also, there will be a few new screens in L02/C02. Some of these Screens will be completed only if a consumer chooses to self direct services. (Again, this may get a little confusing)

PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: COMPONENT CODE/LOCAL CASE NUMBER: 010 / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: I I=INITIAL N=RENEWAL E=ERROR CORRECTION T=TRANSFER R=REVISION D=DELETE PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: (MMDDYYYY) PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC) This screen is the same as was before. Enter Client ID and component code. L02/C02: Since both screens are the same

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY - INITIAL VC060233A
NAME: TURTLE,NINJA CLCN: CLIENT ID: 40011 BEG DT: REV DT: ________ (MMDDYYYY) END DT: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AU AUDIOLOGY ___DOL OT OCCUPATIONAL THERAPY ___HRS BES BEHAVIOR SUPPORT 12 HRS PT PHYSICAL THERAPY ___HRS CS COMMUNITY SUPPORT 100HRS RE RESPITE DAYS DH DAY HABILITATION 120DAYS REH RESPITE HR HRS DI DIETARY ___HRS SP SPEECH/LANGUAGE ___HRS EA EMP ASSISTANCE ___HRS SE SUPPORTED EMP ___HRS NU NURSING HRS DE DENTAL DOL MHM MINOR HOME MOD ____DOL AA ADAPTIVE AIDS ___DOL MHMR MINOR HOME MOD RE ___DOL AAR ADAPTIVE AIDS REQ ___DOL SCV SUPPORT CONSULTAT 10HRS FMSV FMS MONTHLY FEE MONS WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OHFH) READY TO CONTINUE?: _ (Y/N) ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) +Every service entered here will show on CDS Screen The consumer’s choice of (a) provider(s) has not been entered, so the component code and local case number will belong to the Mental Retardation Authority. (Generally, will show CC & LCN of agency logging into CARE.) If answer to “WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N)” is “Y”, the system will take you to the CDS screen. If the answer is “N” then the system will take you to the Program Provider screen. If Support Consultation or Financial Management is entered the answer to “WILL ANY SERVICES BE SELF DIRECTED?” must be ‘Y’. -Notice that abbreviations precede each service -Also notice SCV/FHSV-they are always CDS, and have a “V” behind the abbreviation. All CDS services being used with be delineated with a “V” after the abbreviation No annual cost/cost ceiling/or calculation

NAME: TURTLE,NINJA CLCN: CLIENT ID: 40011 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS BESV BEHAVIOR SUPPORT 12 HRS REV RESPITE DAYS CSV COMMUNITY SUPPORT 100HRS REHV RESPITE HR HRS DHV DAY HABILITATION 120DAYS DEV DENTAL DOL NUV NURSING HRS FMSV FMS MONTHLY FEE MONS SCV SUPPORT CONSULTAT 10HRS WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) CALCULATE?: N (Y/N) CDS ESTIMATED ANNUAL TOTAL: 7,624.00* READY TO ADD? Y (Y/N) ANNUAL COST: 11, COST CEILING: 13,000.00 ACT:___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) Go through this as yes to CDS/PRGP-come back for N in self directed -The units for services eligible to be self-directed will be displayed in this screen. The default option assumes that all eligible services will be self-directed.(If you are sure of units and SDO, change services going to be done by PRGP, to “0” and they will be moved to the 3rd screen.) -Support Consultation and Financial Management Service fee units cannot be changed on this screen. -CDS estimate/annual cost/cost ceiling show All services that are CDS Show “V” behind the Service Abbreviation Can use “N” “N” and then B in ACT: to get back to initial entry screen (for any unit mistakes) CDS Budget is derived here

NAME: TURTLE,NINJA CLCN: CLIENT ID: 40011 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS BESV BEHAVIOR SUPPORT 0 HRS REV RESPITE DAYS CSV COMMUNITY SUPPORT 100HRS REHV RESPITE HR HRS DHV DAY HABILITATION 0 DAYS DEV DENTAL DOL NUV NURSING HRS FMSV FMS MONTHLY FEE MONS SCV SUPPORT CONSULTAT 10HRS WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) CALCULATE?: N (Y/N) CDS ESTIMATED ANNUAL TOTAL: 7,624.00* READY TO ADD? Y (Y/N) ANNUAL COST: 11, COST CEILING: 13,000.00 ACT:___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) Go through this as yes to CDS/PRGP-come back for N in self directed -The units for services eligible to be self-directed will be displayed in this screen. The default option assumes that all eligible services will be self-directed.(If you are sure of units and SDO, change services going to be done by PRGP, to “0” and they will be moved to the 3rd screen.) -Support Consultation and Financial Management Service fee units cannot be changed on this screen. -CDS estimate/annual cost/cost ceiling show All services that are CDS Show “V” behind the Service Abbreviation Can use “N” “N” and then B in ACT: to get back to initial entry screen (for any unit mistakes)

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY INITIAL VC060237A
NAME: TURTLE,NINJA CLCN: CLIENT ID: 37613 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS BES BEHAVIOR SUPPORT 12 HRS DH DAY HABILTATION DAYS DE DENTAL DOL PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 4,337.36 READY TO CONTINUE? Y(Y/N) ANNUAL COST: 11, COST CEILING: 13,000.00 ACT: ___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) For services not being self-direct the units will be displayed in this screen and cannot be changed. On the previous screen, if you have changed any of those services to 0, they will automatically show up here By entering “N” to “ready to add” field and entering “B” on the “ACT” field, you may return to the IPC summary screen. -Shows annual cost/Program Provider cost/cost ceiling------Will not calculate again on this screen -No “V” behind service abbreviation

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: INITIAL VC060238A
NAME: TURTLE,NINJA CLCN: CLIENT ID: 40011 PRGP:CONTRACT: COMPONENT: LOCAL CASE NUMBER: CDSA:CONTRACT: COMPONENT: LOCAL CASE NUMBER: IPC BEGIN DATE: 01/08/ REVISE DATE: END DATE: TOTAL ANNUAL COST : 11, COST CEILING: 13,000.00 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) CONTRACTED PROVIDER NAME: ___________________________ DATE (MMDDYYYY): _________ IDT CERTIFICATION STATEMENT NAME DATE(MMDDYYYY) CASE MANAGER: FORREST SERVICE_________________ NURSE: NURSE JOANNE_____________ _______ CONSUMER/LEGAL REPRESENTATIVE: SPLINTER Note: At the time the initial IPC is entered the provider choice screen has not yet been entered. For this reason the program provider’s and CDSA’s contract and component and their consumer’s local case number will not be displayed.

HCS & TxHmL IPC HARD COPY
The following screens show the proposed IPC’s for both the HCS and TxHmL programs. Going to take a few minutes to go over the changes to the IPC form. Important to note that once these forms are approved for use in the programs, neither The MRA nor the Program Provider will be able to use the old IPC forms (the ones you are currently using) You will need to use the new forms. They will be available on the website once approved and CDS is implemented.

HCS IPC HARD COPY HCS: CDS SERVICES THAT CAN BE SELF-DIRECTED
Supported Home Living Respite Hourly Respite Daily CAN ONLY SELF DIRECT SHL AND RESPITE……..IF YOU HAVE BOTH, MUST DO BOTH

Program provider-enter only units being used under Program provider SDO on the hard copy! See Heading – “Program Provider” services ONLY! We encourage you to indicate these Authorized units only and when you data enter the units in the CARE system, the annual costs will be calculated for you.

CDS services will be indicated on page 2 of the IPC in this section - only services with CDS SDO are placed on this page of the “hard copy” IPC We encourage you to indicate the Authorized units only and after you data enter the units in the CARE , the estimated annual cost will be calculated for you. You may then enter the estimated annual cost on the “hard copy” IPC. Normal IPC procedures (over cost ceiling, etc…) will still be in effect. Any plans (initials, revisions, renewals, transfers) exceeding the 100% cost cap or the authorized amount must be reviewed and authorized by PE/UR. You will still get the message: “Exceeds authorized amount, contact UR,” which means you will need to send in a packet for review.

Signature Screen – note that the CDSA is not required to sign.

Entering the information from the hard copy IPC into CARE
The services entered on Hard-Copy Page 1 (PRGP) + Page 2 (CDS)----will be entered on the first IPC service data entry screen (L02/C02)

TxHmL: CDS SERVICES THAT CAN BE SELF-DIRECTED Audiology Respite
TxHmL HARD COPY IPC TxHmL: CDS SERVICES THAT CAN BE SELF-DIRECTED Audiology Respite Behavior Support Respite Hourly Community Support Speech/Language Day Habilitation Supported Employment Dietary Dental Employee Assistance Minor Home Mod Nursing Adaptive Aids Occupational Therapy Physical Therapy All the TXHmL services can be self directed in the TxHmL program IF YOU SELF DIRECT MHM OR ADAPTIVE AIDS------NO REQUISITION FEE

Service Coordinator-Enter PRGP SDO services on this page of the “hard copy” IPC. We encourage you to indicate the Authorized units only on the “hard copy” IPC and after you data enter the units in the CARE system, the annual costs will be calculated for you. You may then note the estimated annual cost on the “hard copy” IPC.

Enter only CDS SDO services on this page of the “hard copy” IPC
Again, we encourage you to indicate the Authorized units only and let CARE calculate the estimated annual cost for you.

Signature Screen – CDSA not required to sign

Entering the information from the hard copy IPC into CARE
The services entered on Hard-Copy Page 1 (PRGP) + Page 2 (CDS)----will be entered on the first IPC service data entry screen for L02/C02

RENEWALS & REVISIONS TxHmL & HCS
We’re going to cover only the simpler of the renewals or revisions right now and give you a hint of the more complicated ones.

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: RENEWAL VC060233A
NAME: HAMMER, M C JR CLCN: CLIENT ID: 11007 BEG DT: REV DT: (MMDDYYYY) END DT: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AU AUDIOLOGY HRS OT OCCUPATIONAL THERAPY HRS BES BEHAVIOR SUPPORT 10 HRS PT PHYSICAL THERAPY HRS CSV COMMUNITY SUPPORT 80 HRS REV RESPITE DAYS DH DAY HABILITATION 104DAYS REH RESPITE HR HRS DI DIETARY HRS SP SPEECH/LANGUAGE DOL EAV EMP ASSISTANCE HRS SE SUPPORTED EMP _HRS NU NURSING _ HRS DE DENTAL DOL MHM MINOR HOME MOD DOL AA ADAPTIVE AIDS DOL MHMR MINOR HOME MOD RE DOL AAR ADAPTIVE AIDS REQ DOL SCV SUPPORT CONSULTAT 1_ HRS FMSV FMS MONTHLY FEE MONS WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OFH) READY TO CONTINUE?: Y (Y/N) ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) Normal process of annual renewal example. No change in SDO from PRGP or CDS Can add service that does not exist or change units of services already on the IPC. Normal IPC procedures ( over cost ceiling etc…) will still be in effect. Any plans exceeding a service category limit must be sent for review by UR to adjust category limits. In C02 as there are only 2 services to be self directed. Both must be under the same option. If adding SHL or Respite and the other exists on the plan, it must be under the same SDO.

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY – RENEWAL VC060234A
NAME: HAMMER, M C JR CLCN: CLIENT ID: 11007 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CSV COMMUNITY SUPPORT 80 HRS REV RESPITE DAY EAV EMP ASSISTANCE HRS SCV SUPPORT CONSULTAT 1 HRS FMSV MONTHLY FEE MON WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) CALCULATE?: N (Y/N) CDS ESTIMATED ANNUAL TOTAL: 9,011.30* READY TO ADD? Y (Y/N) ANNUAL COST: 12, COST CEILING: 13,000.00 ACT:___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) This screen shows the CDS portion of the IPC. The units for services eligible to be self-directed will be displayed in this screen. Plain renewal cannot change the SDO for any existing services. If this needs to happen, we’ll show you how shortly. The question “WILL ANY SERVICES BE SELF DIRECTED? _ (Y/N)” field value will default to “Y”.

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY – RENEWAL VC060237A
NAME: HAMMER, M C JR CLCN: CLIENT ID: 11007 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS BES BEHAVIOR SUPPORT 10 HRS DH DAY HABILTATION DAYS NU NURSING HRS OT OCCUPATIONAL THERAPY HRS PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: 3,912.44 READY TO CONTINUE? Y(Y/N) ANNUAL COST: 12, COST CEILING: 13,000.00 ACT: ___ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) This screen shows the program provider portion of the IPC. For services not being self-directed the units will be displayed in this screen and cannot be changed. By entering “N” to “ready to add” field and entering “B” on the “ACT” field, you may return to the IPC summary screen.

TxHmL 01-08-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: RENEWAL VC060238A
NAME: HAMMER, M C JR CLCN: CLIENT ID: 11007 PRGP:CONTRACT: COMPONENT: 9DS LOCAL CASE NUMBER: CDSA:CONTRACT: COMPONENT: OMY LOCAL CASE NUMBER: IPC BEGIN DATE: REVISE DATE: END DATE: TOTAL ANNUAL COST : 12, COST CEILING: 13,000.00 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) CONTRACTED PROVIDER NAME: _ICAN DUIT__________________ DATE (MMDDYYYY): _________ IDT CERTIFICATION STATEMENT NAME DATE(MMDDYYYY) CASE MANAGER: DON KING JR _________________ NURSE: NURSE MIMI_____________ _______ CONSUMER/LEGAL REPRESENTATIVE: MIKE TYSON JR Note: This renewal does show the program provider’s and CDSA’s contract, component and their local case number will be displayed.

TxHmL L02:INDIVIDUAL PLAN OF CARE ENTRY: REVISE/RENEWAL VC060233A NAME: HAMMER, M C JR CLCN: CLIENT ID: 11007 BEG DT: REV DT: (MMDDYYYY) END DT: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AU AUDIOLOGY HRS OT OCCUPATIONAL THERAPY HRS BES BEHAVIOR SUPPORT 10 HRS PT PHYSICAL THERAPY HRS CSV COMMUNITY SUPPORT 80 HRS REV RESPITE DAYS DH DAY HABILITATION 104DAYS REH RESPITE HR HRS DI DIETARY HRS SP SPEECH/LANGUAGE DOL EAV EMP ASSISTANCE HRS SE SUPPORTED EMP _HRS NU NURSING _ HRS DE DENTAL DOL MHM MINOR HOME MOD DOL AA ADAPTIVE AIDS DOL MHMR MINOR HOME MOD RE DOL AAR ADAPTIVE AIDS REQ DOL SCV SUPPORT CONSULTAT 1_ HRS FMSV FMS MONTHLY FEE MONS WILL ANY SERVICES BE SELF DIRECTED? Y (Y/N) RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OFH) READY TO CONTINUE?: Y (Y/N) ACT: ____ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC) Here we get a little tricky…….. Here is an example of what we mean.

Behavior Support Community Support
CHANGING SERVICE DELIVERY OPTION(SDO) FOR A SPECIFIC SERVICE REVISION & RENEWAL (currently TxHmL Only) PrgP SDO CDS SDO Behavior Support Community Support Day Habilitation Employment Assistance Nursing Respite Occupational Therapy On a revision or renewal. If you have all these services and you decide to change one service from PRPG SDO to CDS SDO, thus changing the contract under which the service is being provided………you are going to have to do something completed different. These more complex ones involve the use of the transfer screen. It says Revise/Annual and it is, but you will have to use L06 (or C06?). We will respond to questions about these after Debra’s/Stephen’s presentation or later this afternoon. Stephen Kreger/Debra Abercrombie will describe how that screen works right after our break. The reason why? - changing contracts under which the service is provided

CONTACT INFO PATRICK MARTIN (512) GEOFF SHUTE (512)

Questions and Answers

Transfers: adding, changing, and discontinuing an individual’s participation in the CDS option

A transfer occurs whenever a contract number (vendor number) associated with an individual is added, ended, or changed. A transfer in CARE occurs when a individual moves from a 1. Program Provider (PrgP) to PrgP, 2. PrgP to Consumer Directed Services Agency (CDSA), 3. CDSA to CDSA, or 4. CDSA to PrgP.

When the individual has selected a PrgP and/or a CDSA, the transfer effective date must be agreed upon by the all of the appropriate entities involved: the transferring program provider, the receiving program provider, the current program provider, the CDS Agency (ies), and the individual/LAR.

The receiving/current PrgP or the MRA’s service coordinator must mail or fax a copy of the Request for Transfer Form and a copy of the transfer IPC to the appropriate Program Enrollment (PE) staff person after the data entry has been completed.

Subchapter D §41.403 Transfer Process
(a) An individual's CDSA must process a request by the individual or LAR to transfer from one CDSA to another CDSA in accordance with transfer procedures and requirements of the individual's program. (b), (d), and (e) apply to the transferring CDSA, employer or Designated Representative (DR), and the receiving CDSA, respectively.

(c) Within five working days after the receipt of a request to transfer, the case manager (HCS) or service coordinator must (TxHmL): (1) process the individual's request to transfer from one CDSA to another CDSA in accordance with the requirements of the individual's program and this chapter; (2) calculate the number of units or amount of funds needed to complete the service plan (IPC) period based on the individual's current service plan (use CDSA Transfer Information Form 1742/1743); (3) revise the service plan to indicate the number of units or amount of funds calculated in this subsection effective the date of transfer; and

(A) approve only the units and funds calculated as needed if units and funds remaining in the budget meet or exceed the needed number or units or amount of funds to complete the service period, or approve only the amount remaining in the budget for the period remaining in the individual's service plan; and (B) provide a copy of the transferring service plan to the receiving CDSA and employer before the effective date of the transfer; and (4) provide a copy of the individual's revised service plan to the transferring CDSA, the receiving CDSA, and the employer or DR.

HCS CARE Screen Sequence 1. C06: Transferring Provider. 2
HCS CARE Screen Sequence 1. C06: Transferring Provider 2. C09: Receiving Provider 3. C06: Receiving Provider 4. C02: Receiving Provider 5. C06: Receiving Provider TxHmL CARE Screen Sequence 1. L09: Transferring MRA 2. L06: Transferring MRA 3. L02: Transferring MRA 4. L06: Transferring MRA

HCS Transfer Example In this transfer example, the individual will transfer from the current Program Provider to a new Program Provider and initiate the CDS option (adding a CDSA).

07-01-08 C06: TRANSFER: CONTRACT/SERVICES: A/C/D VC060311
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: 1234_______ COMPONENT CODE/LOCAL CASE NUMBER: 8XX / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: CONTRACT NUMBER: TRANSFER EFFECTIVE DATE: (MMDDYYYY) FOR ADD ONLY: 1. CHANGING PrgP OR CDS AGENCY? Y (Y/N) 2. ADDING A PrgP OR CDS AGENCY? Y (Y/N) 3. CHANGING SERVICE DELIVERY OPTIONS? Y (Y/N) TYPE OF ENTRY:A (A/ADD,C/CHANGE,D/DELETE) *** PRESS ENTER *** ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC)

Matrix for CARE Screen C06 Questions Answer Combinations
Valid Valid Valid Valid Valid Valid Valid InValid 1. ARE YOU CHANGING YOUR Y N N Y Y N Y N PROGRAM PROVIDER OR CDS AGENCY? 2. ARE YOU ADDING A PROGRAM N N Y Y N Y Y N PROVIDER OR CDS AGENCY? 3. ARE YOU CHANGING SERVICE N Y N N Y Y Y N DELIVERY OPTIONS?

Explanations of the questions on CARE Header Screen C06/L06
Service Delivery Option (SDO) means having waiver services delivered by a PrgP and/or by the Individual self-directing the services (with support from the CDSA). Explanations of the questions on CARE Header Screen C06/L06 1. Changing a PrgP or CDSA occurs when the SDO currently exists. 2. Adding a PrgP or CDSA occurs when a SDO will be added where it does not exist. 3. Changing SDO occurs when an existing service (s) is moved from one SDO to the other SDO (contract/vendor numbers do not change).

07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311 NAME : TYE,BEAU
C06: TRANSFER CONTRACT/SERVICES: ADD VC NAME : TYE,BEAU CLIENT ID: EFFECTIVE DATE: (MMDDYYYY) SERVICE SDO CLAIM - PD/UNPD = REMAIN TO USE UNITS ADAPTIVE AIDS PRGP _____ CASE MANAGEMENT PRGP _____ DAY HABILITATION PRGP _____ MINOR HOME MODS PRGP _____ NURSING PRGP _____ RESPITE HOURLY PRGP _____ SUPPORTED HOME LIVING PRGP _____ READY TO ADD? Y (Y/N)

07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060316
NAME : TYE,BEAU CLIENT ID: 1234 TRANSFER EFFECTIVE DATE: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8XX / CONTRACT NUMBER: CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: ________ RECEIVING: Enter only if changing/adding provider(s) SERVICE COUNTY: ____ LOCATION CODE: ____ RESDENTIAL TYPE: ___ PRGP: COMP/LCN: 8YY / __________ CONTRACT NUMBER: CDSA: COMP/LCN: 8ZZ / __________ CONTRACT NUMBER: DOLLAR AMTS: AA MHM DENTAL OTHER SVCS TO BE PROV NOW TO TRANS DT: TRANSFER ACCEPTED? _ (Y/N) BY: _________________________ DATE: ________ (MMDDYYYY) C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: __________________ DATE: ________ (MMDDYYYY) READY TO ADD? Y (Y/N) ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

07-01-08 C09:REGISTER CLIENT UPDATE VC060420
PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: CLIENT ID: 1234 __________ COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD. *** PRESS ENTER *** ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

CLIENT LAST NAME/SUF: TYE CLIENT ID : 1234 CLIENT FIRST NAME : BEAU COMPONENT : 8YY CLIENT MIDDLE NAME : LOCAL CASE NUMBER : Y420__________ SEX : M_ ETHNICITY : W_ CLIENT BIRTHDATE (MMDDYYYY): SOCIAL SECURITY NUMBER : (N=NONE, U=UNKNOWN) MEDICAID NUMBER : MEDICARE NUMBER: ____________ PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) REGISTRATION EFFECTIVE DATE : (MMDDYY) TIME (HHMM A/P): _____ LEGAL GUARDIANSHIP : 1 MARITAL STATUS: ESTIMATED ANNUAL GROSS FAMILY INCOME: 7258 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP : TS (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? Y (Y/N) ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: CLIENT ID: 1234__________ COMPONENT CODE/LOCAL CASE NUMBER: 8ZZ / __________ NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD. *** PRESS ENTER *** ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

CLIENT LAST NAME/SUF: TYE CLIENT ID : 1234 CLIENT FIRST NAME : BEAU COMPONENT : 8ZZ CLIENT MIDDLE NAME : LOCAL CASE NUMBER : Z420__________ SEX : M_ ETHNICITY : W_ CLIENT BIRTHDATE (MMDDYYYY): SOCIAL SECURITY NUMBER : (N=NONE, U=UNKNOWN) MEDICAID NUMBER : MEDICARE NUMBER: ____________ PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) REGISTRATION EFFECTIVE DATE : (MMDDYY) TIME (HHMM A/P): _____ LEGAL GUARDIANSHIP : 1 MARITAL STATUS: 2 ESTIMATED ANNUAL GROSS FAMILY INCOME: 7258 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP : TS (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? Y (Y/N) ACT: ____ (C00/PROV DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

07-01-08 C06: TRANSFER: CONTRACT/SERVICES: A/C/D VC060311
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: 1234_____ OMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: CONTRACT NUMBER: TRANSFER EFFECTIVE DATE: FOR ADD ONLY: CHANGING PrgP OR CDS AGENCY? _ (Y/N) ADDING A PrgP OR CDS AGENCY? _ (Y/N) CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N) TYPE OF ENTRY: C (A/ADD,C/CHANGE,D/DELETE) *** PRESS ENTER *** ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC)

C06: TRANSFER CONTRACT/SERVICES: ADD VC NAME : TYE,BEAU CLIENT ID: EFFECTIVE DATE: (MMDDYYYY) SERVICE SDO CLAIM PD/UNPD TO USE = REMAIN NEW UNITS SDO ADAPTIVE AIDS PRGP P____ CASE MANAGEMENT PRGP P____ DAY HABILITATION PRGP P____ MINOR HOME MODS PRGP P____ NURSING PRGP P____ RESPITE HOURLY PRGP C____ SUPPORTED HOME LIVING PRGP C____ READY TO CHANGE? Y (Y/N)

07-01-08 C06: TRANSFER CONTRACT/SERVICES: ADD VC060311 NAME : TYE,BEAU
C06: TRANSFER CONTRACT/SERVICES: ADD VC NAME : TYE,BEAU CLIENT ID: EFFECTIVE DATE: (MMDDYYYY) SERVICE SDO CLAIM -PD/UNPD - TO USE REMAIN NEW UNITS SDO ADAPTIVE AIDS PRGP P____ CASE MANAGEMENT PRGP P____ DAY HABILITATION PRGP P____ MINOR HOME MODS PRGP P____ NURSING PRGP P____ RESPITE HR CDSA C____ SUPPORTED HOME LIVING CDSA C____ CONFIRM NEW SDO? Y (Y/N)

07-01-08 C06: CONSUMER TRANSFER CONTRACT/SERVICES: CHANGE VC060316
NAME : TYE,BEAU CLIENT ID: 1234 TRANSFER EFFECTIVE DATE: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8XX / CONTRACT NUMBER: CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________ RECEIVING: Enter only if changing/adding provider(s) SERVICE COUNTY: LOCATION CODE: OHFH RESIDENTIAL TYPE: 3 PRGP: COMP/LCN: 8YY / Y444_____ CONTRACT NUMBER: CDSA: COMP/LCN: 8ZZ/ Z420 _____ CONTRACT NUMBER: DOLLAR AMTS: AA MHM DENTAL OTHER SVCS TO BE PROV NOW TO TRANS DT: TRANSFER ACCEPTED? _ (Y/N) BY: _________________________ DATE:____________ C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: _______ DATE: ________ (MMDDYYYY) READY TO CHANGE? Y (Y/N) ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

07-01-08 C02:INDIVIDUAL PLAN OF CARE VC060230
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: 1234__________ COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: T I=INITIAL N=RENEWAL E=ERROR CORRECTION T=TRANSFER R=REVISION D=DELETE PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: ________ (MMDDYYYY) PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

07-01-08 C02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232A
NAME: TYE,BEAU CLCN: 8YY Y420 CLIENT ID: 1234 BEG DT: REV DT: (MMDDYYYY) END DT: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMM CASE MANAGEMENT ___ MONS SHLV SUPPORTED HOME LIVING HRS SP SPEECH/LANGUAGE _____ HRS FC HCS FOSTER CARE __ DAYS OT OCCUPATIONAL THERA _____ HRS SL SUPERVISED LIVING __ DAYS PT PHYSICAL THERAPY _____ HRS RSS RES SUPPORT SVC __ DAYS DI DIETARY _____ HRS NU NURSING HRS PS PSYCHOLOGY _____ HRS REHV RESPITE HR HRS AU AUDIOLOGY _____ HRS RE RESPITE __ DAYS SW SOCIAL WORK _____ HRS DH DAY HAB DAYS SE SUPPORTED EMP _____ HRS FMSV FMS MONTHLY FEE MONS SCV SUPPORT CONSULTAT _____ HRS DE DENTAL __ DOL AA ADAPTIVE AIDS __ DOL MHM MINOR HOME MODS DOL RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OHFH) READY TO CONTINUE? Y (Y/N) ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1

NAME: TYE,BEAU CLCN: 8ZZ Z CLIENT ID: 1234 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS REHV RESPITE HR HRS SHLV SUPPORTED HOME LIVING HRS FMSV FMS MONTHLY FEE MONS CDS ESTIMATED ANNUAL TOTAL: $9,206.86 READY TO COMTINUE? Y (Y/N) ANNUAL COST: $36, COST CEILING: 78,967.75 ACT: ____ (F/FWD,B/BK,L00MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

NAME: TYE,BEAU CLCN: 8YY Y CLIENT ID: 1234 IPC BEGIN DATE: REVISE DATE: END DATE: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS CMMB CASE MGMT SELF DIR MONS NU NURSING HRS DH DAY HABILITATION DAYS REH RESPITE HR HRS SHL SUPPORTED HOME LVG HRS AA ADAPTIVE AIDS DOL MHM MINOR HOME MODS DOL PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: $27,561.92 READY TO CONTINUE? Y (Y/N) ANNUAL COST: $36, COST CEILING: $78,967.75 ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

NAME: TYE,BEAU CLCN: CLIENT ID: 1234 PRGP: CONTRACT: COMPONENT: 8YY LOCAL CASE NUMBER : Y420 CDSA: CONTRACT: COMPONENT: 8ZZ LOCAL CASE NUMBER : Z444 IPC BEGIN DATE: REVISE DATE: END DATE: TOTAL ANNUAL COST: $36, COST CEILING: $78,967.75 ARE ANY DIRECT SERVICES PROVIDED BY A RELATIVE/GUARDIAN? Y (Y/N) CONTRACTED PROVIDER NAME: APRIL MAY____________________ DATE (MMDDYYYY): IDT CERTIFICATION STATEMENT DATE NAME (MMDDYYYY) CASE MANAGER : MAC TRUCK _____________________ NURSE : N. RATCHET RN__________________ CONSUMER/LEGAL REPRESENTATIVE : TYE,BEAU READY TO ADD? Y (Y/N) ACT: ____ (C00/PROV ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

07-01-08 C06:TRANSFER: CONTRACT/SERVICES: A/C/D VC060311
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: 1234_____ COMPONENT CODE/LOCAL CASE NUMBER: 8YY / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: CONTRACT NUMBER: TRANSFER EFFECTIVE DATE: FOR ADD ONLY: CHANGING PrgP OR CDS AGENCY? _ (Y/N) ADDING A PrgP OR CDS AGENCY? _ (Y/N) CHANGING SERVICE DELIVERY OPTIONS? _ (Y/N) TYPE OF ENTRY: C (A/ADD,C/CHANGE,D/DELETE) *** PRESS ENTER *** ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC)

07-12-08 C06: TRANSFER CONTRACT/SERVICES: CHANGE VC060316
NAME : TYE,BEAU CLIENT ID: 1234 TRANSFER EFFECTIVE DATE: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8XX / CONTRACT NUMBER: CDSA: COMP/LCN: ___ / ________ CONTRACT NUMBER: _________ RECEIVING: Enter only if changing/adding provider(s) SERVICE COUNTY: 8YY LOCATION CODE: OHFH_ RESIDENTIAL TYPE: 3 PRGP: COMP/LCN: 8YY / Y420 ____ CONTRACT NUMBER: CDSA: COMP/LCN: 8ZZ / Z444_____ CONTRACT NUMBER: DOLLAR AMTS: AA MHM DENTAL OTHER SVCS TO BE PROV NOW TO TRANS DT: TRANSFER ACCEPTED? Y (Y/N) BY: ART WORK_______________ DATE: C.O. AUTHORIZE TRANSFER? _ (Y/N) BY: _______ DATE: ________ (MMDDYYYY) READY TO TRANSFER? Y (Y/N) ACT: ____ (C00/HCS DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

TxHmL Transfer Example
In this transfer example, the individual will transfer from the current Program Provider to a new Program Provider and initiate the CDS option (adding a CDSA).

L09:REGISTER CLIENT UPDATE VC PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: CLIENT ID: 9876______ COMPONENT CODE/LOCAL CASE NUMBER: 8SS / __________ NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD *** PRESS ENTER *** ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

10-15-08 L09:REGISTER CLIENT UPDATE VC060425
CLIENT LAST NAME/SUF: ABSENT CLIENT ID : 9876 CLIENT FIRST NAME : MARCUS COMPONENT : 8SS CLIENT MIDDLE NAME : LOCAL CASE NUMBER : S777 SEX : M ETHNICITY : W CLIENT BIRTHDATE (MMDDYYYY): SOCIAL SECURITY NUMBER : (N=NONE, U=UNKNOWN) MEDICAID NUMBER : MEDICARE NUMBER: ____________ PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) REGISTRATION EFFECTIVE DATE: (MMDDYY) TIME (HHMM A/P): 10:05A LEGAL GUARDIANSHIP : 2 MARITAL STATUS: ESTIMATED ANNUAL GROSS FAMILY INCOME: 7252 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP : __ (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? Y (Y/N) ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

L09:REGISTER CLIENT UPDATE VC PLEASE ENTER AT LEAST ONE OF THE FOLLOWING: CLIENT ID: 9876______ COMPONENT CODE/LOCAL CASE NUMBER: 8TT / __________ NOTE: TO ASSIGN A PROVIDER'S LOCAL CASE NUMBER FOR NEW ENROLLMENTS USE THE PROVIDERS COMPONENT CODE IN THE ABOVE FIELD *** PRESS ENTER *** ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

10-15-08 L09:REGISTER CLIENT UPDATE VC060425
CLIENT LAST NAME/SUF: ABSENT CLIENT ID : 9876 CLIENT FIRST NAME : MARCUS COMPONENT : 8TT CLIENT MIDDLE NAME : LOCAL CASE NUMBER : T10 SEX : M ETHNICITY : W CLIENT BIRTHDATE (MMDDYYYY): SOCIAL SECURITY NUMBER : (N=NONE, U=UNKNOWN) MEDICAID NUMBER : MEDICARE NUMBER: ____________ PRESENTING PROBLEM : 2 (1=MH, 2=MR, 3=ECI/DD, 4=SA, 5=RC) REGISTRATION EFFECTIVE DATE: (MMDDYY) TIME (HHMM A/P): 10:07A LEGAL GUARDIANSHIP : 2 MARITAL STATUS: ESTIMATED ANNUAL GROSS FAMILY INCOME: 7252 FAMILY SIZE : 1 SERVICE PARTICIPANT GROUP : __ (CB, SB, PD, HC, TS, EC, UC) READY TO UPDATE? Y (Y/N) ACT: ____ (L00/MRA DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

10-15-08 L06: CONSUMER TRANSFER: CONTRACT/SERVICES: A/C/D VC060311
PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: 9876 COMPONENT CODE/LOCAL CASE NUMBER: 8WW / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: CONTRACT NUMBER: TRANSFER EFFECTIVE DATE: (MMDDYYYY) FOR ADD ONLY: 1. CHANGING PROGRAM PROVIDER OR CDS AGENCY? Y (Y/N) ADDING A PROGRAM PROVIDER OR CDS AGENCY? Y (Y/N) 3. CHANGING SERVICE DELIVERY OPTIONS? Y (Y/N) TYPE OF ENTRY: A (A/ADD,C/CHANGE,D/DELETE) *** PRESS ENTER *** ACT: ____ (L00/TXHML DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC)

L06: TRANSFER CONTRACT/SERVICES: ADD VC NAME : ABSENT, MARCUS CLIENT ID: EFFECTIVE DATE: (MMDDYYYY) SERVICE SDO CLAIM - PD/UNPD = REMAIN TO USE NEW SDO UNITS ADAPTIVE AIDS PRGP _____ P DAY HABILITATION PRGP _____ P MINOR HOME MODS PRGP _____ P NURSING PRGP _____ P RESPITE HOURLY PRGP _____ C COMMUNITY SUPPORT PRGP _____ C READY TO ADD? Y (Y/N)

L06: TRANSFER CONTRACT/SERVICES: ADD VC NAME : ABSENT, MARCUS CLIENT ID: EFFECTIVE DATE: (MMDDYYYY) SERVICE SDO CLAIM - PD/UNPD TO USE = REMAIN NEW SDO UNITS ADAPTIVE AIDS PRGP _____ P DAY HABILITATION PRGP _____ P MINOR HOME MODS PRGP _____ P NURSING PRGP _____ P RESPITE HOURLY PRGP _____ C COMMUNITY SUPPORT PRGP _____ C READY TO CONFIRM? Y (Y/N)

NAME : ABSENT,MARCUS CLIENT ID: 9876 TRANSFER EFFECTIVE DATE: 10152008
L06:CONSUMER TRANSFER CONTRACT/SERVICES: ADD VC060238 NAME : ABSENT,MARCUS CLIENT ID: 9876 TRANSFER EFFECTIVE DATE: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8WW / CONTRACT NUMBER: CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________ RECEIVING: Enter only if changing/adding provider (s) SERVICE COUNTY: 006 LOCATION CODE: OHFH RESIDENTIAL TYPE: 3 PRGP: COMP/LCN: 8SS / S777______ CONTRACT NUMBER: CDSA: COMP/LCN: 8TT / T10______ CONTRACT NUMBER: DOLLAR AMTS: AA MHM DENTAL OTHER SVCS TO BE PROV NOW TO TRANS DT: TRANSFER ACCEPTED?_ (Y/N) BY: ___________________ DATE:_________ READY TO ADD? Y (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

PLEASE ENTER ONE OF THE FOLLOWING: CLIENT ID: 9876______ COMPONENT CODE/LOCAL CASE NUMBER: 8SS / __________ MEDICAID NUMBER: _________ PLEASE ENTER THE FOLLOWING: TYPE OF ENTRY: T I=INITIAL N=RENEWAL E=ERROR CORRECTION T=TRANSFER R=REVISION D=DELETE PLEASE ENTER FOR INITIAL PLANS ONLY: BEGIN DATE: ________ (MMDDYYYY) PLEASE SELECT FOR INITIAL PLANS WITH THE FOLLOWING SLOT TYPES: 16=LA/REF, 17=TXHML/REF, 18=TXHML/WL _ 365 DAYS _ 270 DAYS _ 180 DAYS *** PRESS ENTER *** ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY:TRANSFER VC060233A
NAME: ABSENT,MARCUS CLCN: 8SS CLIENT ID: 9876 BEG DT: REV DT: (MMDDYYYY) END DT: SERVICE CATEGORY UNITS SERVICE CATEGORY UNITS AU AUDIOLOGY DOL OT OCCUPATIONAL THERAPY DOL BES BEHAVIOR SUPPORT HRS PT PHYSICAL THERAPY HRS CSV COMMUNITY SUPPORT HRS RE RESPITE DAYS DH DAY HABILITATION DAYS REHV RESPITE HR HRS DI DIETARY HRS SP SPEECH/LANGUAGE HRS EA EMP ASSISTANCE HRS SE SUPPORTED EMP HRS NU NURSING HRS DE DENTAL DOL MHM MINOR HOME MOD DOL AA ADAPTIVE AIDS DOL MHMR MINOR HOME MOD RE 81 DOL AAR ADAPTIVE AIDS REQ DOL SCV SUPPORT CONSULTATION HRS FMSV FMS MONTHLY FEE MONS RESIDENTIAL TYPE: 3 (2-5) LOCATION: OHFH (OFH) READY TO CONTINUE?: Y (Y/N) ACT: ___ F/FWD,B/BK,(L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232B
NAME: ABSENT,MARCUS CLCN: 8SS S777 CLIENT ID: 9876 BEG DT: REVISE DT: (MMDDYYYY) END DATE: SERVICE CATEGORY UNITS CSV COMMUNITY SUPPORT HRS FM SV FMS MOS REHV RESPITE HR HRS SCV SUPPORT CONSULTATION HRS CALCULATE?: Y (Y/N) CDS ESTIMATED ANNUAL TOTAL: $3,662.94 READY TO CONTINUE? Y (Y/N) ANNUAL COST: $11, COST CEILING: $13,000.00 ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060232C
NAME: ABSENT,MARCUS CLCN: 8SS S777 CLIENT ID: 9876 BEG DT: REVISE DT: (MMDDYYYY) END DATE: SERVICE CATEGORY UNITS CS COMMUNITY SUPPORT HRS DH DAY HABILITATION DAYS NU NURSING HRS REH RESPITE HR HRS AA ADAPTIVE AIDS DOL AAR ADAPTIVE AIDS RE 28 DOL MHM MINOR HOME MODS 750 DOL MHMR MINOR HOME MODS RE DOL PROGRAM PROVIDER ESTIMATED ANNUAL TOTAL: $8,309.21 READY TO CONTINUE? Y (Y/N) ANNUAL COST: $ 11, COST CEILING: $13,000.00 ACT: ____ (F/FWD,B/BK,L00/AUTH ENTRY MENU,A/MA MAIN MENU,HLP(PF1)/SCRNDOC)

10-15-08 L02:INDIVIDUAL PLAN OF CARE ENTRY: TRANSFER VC060238A
NAME: ABSENT,MARCUS CLCN: 8SS S777 CLIENT ID: 9876 PRGP:CONTRACT: COMPONENT: 8SS LOCAL CASE NUMBER: S777 CDSA:CONTRACT: COMPONENT: 8TT LOCAL CASE NUMBER: T10 IPC BEGIN DATE: REVISE DATE: END DATE: TOTAL ANNUAL COST : 3, COST CEILING: 13,000.00 ARE ANY DIRECT SERVICES STAFFED BY A RELATIVE/GUARDIAN? N (Y/N) CONTRACTED PROVIDER NAME: GENE POOLE DATE (MMDDYYYY): IDT CERTIFICATION STATEMENT NAME DATE(MMDDYYYY) CASE MANAGER: JUNE MAY _______________________________ NURSE: NA________________________________________________ CONSUMER/LEGAL REPRESENTATIVE: ABSENT,MARCUS_____ READY TO ADD? : Y (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/MA MAIN MENU, HLP(PF1)/SCRN DOC)

NAME : ABSENT,MARCUS CLIENT ID: 9876 TRANSFER EFFECTIVE DATE: 10152008
L06:CONSUMER TRANSFER CONTRACT/SERVICES: ADD VC060316 NAME : ABSENT,MARCUS CLIENT ID: 9876 TRANSFER EFFECTIVE DATE: TRANSFERRING: SERVICE COUNTY: 006 LOCATION CODE: OHFH PRGP: COMP/LCN: 8WW / CONTRACT NUMBER: CDSA: COMP/LCN: ___ / __________ CONTRACT NUMBER: _________ RECEIVING: Enter only if changing/adding provider (s) SERVICE COUNTY: 006 LOCATION CODE: OHFH RESIDENTIAL TYPE:___ PRGP: COMP/LCN: 8SS / S777______ CONTRACT NUMBER: CDSA: COMP/LCN: 8TT / T10______ CONTRACT NUMBER: DOLLAR AMTS: AA MHM DENTAL OTHER SVCS TO BE PROV NOW TO TRANS DT: TRANSFER ACCEPTED? Y (Y/N) BY: PERCY VEER________ DATE: READY TO TRANSFER? Y (Y/N) ACT: ____ (L00/AUTH DATA ENTRY MENU, A/HCS MAIN MENU, HLP(PF1)/SCRN DOC

Abuse, Neglect and Exploitation (ANE)--
What will change with the implementation of CDS and what will stay the same?

Adult Protective Services (APS)
Organization of The Texas Department of Family and Protective Services (DFPS) Two branches: Adult Protective Services (APS) Child Protective Services (CPS)

Organization of DFPS, cont.
APS breaks down into 2 divisions: In-Home Investigations Facility Investigations CPS is divided along lines of service delivery

APS only conducts investigations into ANE allegations involving: individuals over the age of 65, and Individuals between the ages of 18 and 64 who have a disability.

One exception in APS is with regard to facility investigations. If an minor individual with a disability is receiving services in a facility, or by a person employed by an HCS or TxHmL provider agency, allegations of ANE perpetrated by the facility, or the provider agency’s employee will be investigated by APS. CPS works on the supposition that for an individual under the age of 18, the parent is ultimately responsible.

How it Works Now Providers are still required to inform all individuals or their LARs, regardless of the service delivery option they choose, how to report allegations of ANE to DFPS Providers are still required to provide all individuals or their LARs with the toll-free number for reporting ANE, regardless of the service delivery option they choose

How it Works Now, cont. DFPS Facility Investigations Division of APS investigates all allegations of ANE involving individuals who receive services in the HCS or TxHmL programs who are being served through a provider agency. Providers are required to follow all program rules regarding DFPS facility investigations.

What will change? When an individual or his LAR chooses to self-direct his services and hires employees directly, allegations of ANE involving employees of the individual or the LAR (employer) will be conducted by DFPS’ In-Home Adult Protective Services division.

What will change, Cont. The In-Home division of APS does not conduct ANE investigations involving individuals under the age of 18.

What will change, Cont. In the event a minor individual receiving HCS
services under the CDS option is an alleged victim of ANE by an employee of the CDS employer: Law enforcement should be notified, and CPS may become involved only if there is suspicion the parent or legal guardian or the minor is being negligent in the care or supervision of the child.

What will change, Cont. When DFPS In-Home division conducts an ANE investigation involving a direct employee or contractor of the individual or LAR, the provider or MRA is not responsible to follow program rules related to APS facility investigations involving the provider’s employees or contractors.

What will change, Cont. The individual or LAR who chooses CDS and hires employees or contractors is responsible to train his employees and contractors regarding the required time frame for reporting ANE, and is responsible to provide his employees and contractors with the toll-free number for reporting.

The Role of the Case Manager or Service Coordinator when Serving Individuals using the Consumer-Directed Services Option Winter, 2007

Case Management and Service Coordination
Includes: Monitoring Facilitating Choice Identifying Additional Supports Coordinating Safeguards

Monitoring

Monitoring Activities
Home visits to talk with individual Review of progress on service plan outcomes Review of documentation maintained by employer Review of CDSA reports Review of the effectiveness of service back-up plans, as necessary Review of any corrective action required

CDSA Reports The CDSA is required to provide a report quarterly, or monthly, if requested, to the CM/SC that addresses each service delivered through the CDS option, including the actual number of hours or units of service delivered The employer (individual or LAR) also receives this report

Communication with CDSA
The CDSA is required to provide information about an individual’s participation in the CDS option w/in 3 working days of request by a CM/SC The CDSA must document and notify a CM/SC of issues or concerns related to an individual’s participation in CDS

Budget Revisions and Approval
The employer or DR is required to make budget revisions when required by the CDSA, the CM/SC, the individual’s service team or a DADS representative

Choice

Enrollment in the CDS Option
SC is required to present CDS option at time of enrollment CM or SC is required to present CDS option annually to individual or LAR If individual or LAR requests additional information or requests enrollment into CDS option, CM or SC must comply within 5 working days CM or SC must assist an individual or LAR to complete enrollment forms

Transfer to Another CDSA
Transferring CDSA is required to notify employer and individual’s CM or SC in writing of units and dollars remaining in each budget as of scheduled transfer date Transferring CDSA is required to provide a final report to CM or SC within 5 days after transfer CM or SC has 5 working days to complete activities necessary for transfer to a different CDSA

Additional Supports

Designated Representative
Service planning team may recommend the employer appoint a Designated Representative (DR) to assist or perform employer responsibilities based on documentation provided by the CDSA.

Support Consultation Service planning team must operate within existing budget to add support consultation funds Individual or DR must justify support consultation services, verify with CM or SC non-program resources are not available Support consultation must be approved by Service Planning Team

Support Consultation cont.
Support Consultation services may be approved if: (1) the individual receiving CDS will become employer within 6 months; (2) the employer or DR demonstrates need for Support Consultation; (3) the individual’s health and welfare may regress without additional supports for managing service providers: (4) the service planning team has justified need for the service for other reasons.

Support Consultation cont.
If service planning team approves Support Consultation, the service planning team is required to: (1) approve the funds, the duration and frequency of service; (2) assist with development of plan (3) approve the outcomes for Support Consultation; and (4) terminate Support Consultation when outcomes are met.

Support Advisor Responsibilities
Support Advisor is required to notify CM or SC: (1) when Support Consultation outcomes have been met; (2) if person receiving support consultation is unable or unwilling to cooperate with service delivery; (3) of progress and status of the Support Consultation service.

Safeguards

Service Back-up Plans The service planning team must describe:
(1) which CDS services are critical; and (2) the length of time that constitutes a service interruption or an emergency for the individual. The service planning team must approve all service back-up plans prior to implementation (CDS form 1740)

Corrective Action Plans
A CM or SC or service planning team may request a corrective action plan (CAP) from an employer or DR. CAP to be provided in 10 days. A CAP can be requested if employer or DR: (1) hires ineligible service provider; (2) submits incomplete, inaccurate or late documentation of service delivery; (3) does not follow budget; (4) does not comply with program requirements re: CDS option; or (5) does not meet other employer responsibilities.

Corrective Action Plans cont.
The employer or DR may request assistance from the CM or SC or others if the CAP is related to program rules or requirements A CAP (CDS form 1741) must include: (1) the reason CAP is required; (2) the action to be taken; (3) the person responsible for each action; (4) the date the action must be completed.

Termination of Participation in the CDS Option
CM or SC is required to convene service planning team to address issues that may warrant immediate termination of participation in CDS Service planning team may recommend termination of CDS option if attempted interventions have not resulted in: (1) elimination of immediate jeopardy; (2) successful delivery of services; (3) employer responsibilities being met; (4) successful implementation of CAPs; or (5) accessing other supports to assist employer in meeting employer responsibilities.

Termination of Participation in the CDS Option cont.
CM or SC is required to complete following upon receipt of recommendation for involuntary termination from CDSA or other party: (1) assist in development and implementation of CAP; (2) document attempted interventions; and (3) convene service planning team to: (A) consider recommendation(s) made by CDSA or other party; (B) recommend additional interventions; (C) make revisions to service plan.

When an individual’s participation in CDS option is terminated, CM or SC is required to: (1) ensure continuity of those services that were being delivered through CDS option; and (2) document arrangements made to ensure continuity of services for services previously delivered through CDS option.

When service planning team recommends termination of CDS option, CM or SC is required to document: (1) reason(s) for recommendation; (2) conditions and timeframes established by service planning team for re-enrollment into CDS option; (3) justification for termination timeframes that exceed 90 days; and (4) conditions and timeframes established by hearing officer, if applicable.

For HCS and TxHmL, recommendations for termination must be submitted to DADS Access and Intake, Program Enrollments for review and processing.

Re-enrollment for Participation in the CDS Option
Individual or LAR is required to notify CM or SC to request re-enrollment into CDS option

Re-enrollment for Participation in the CDS Option cont.
Prior to re-enrollment into CDS option, CM or SC must: (1) review reason for suspension or termination; (2) verify minimum 90-day period and any other conditions have been met; (3) verify resolution of each issue that contributed to suspension or termination; and (4) refer request for re-enrollment to service planning team to: (A) revise service plan and re-enroll into CDS; OR (B) recommend denial to DADS Access and Intake, Program Enrollment for review and processing

Re-enrollment for Participation in the CDS Option cont.
CDSA is required to notify CM or SC in writing within 2 working days of any repeat of prior noncompliance or additional noncompliance with requirements of individual’s program or CDS option

Due Process CM or SC provides an oral explanation of an “adverse” action recommended by a service planning team. Any recommendations for denial, reduction, suspension or termination of current or proposed CDS services must be submitted to DADS, Access and Intake, Program Enrollment for review. DADS will generate written notification of the right to a fair hearing as appropriate.

Monitoring and Oversight of HCS and TxHmL Providers who Serve Individuals using the CDS Option Winter, 2007

HCS Provider Certification Reviews
Reviews will include individuals who receive CDS in review sample CDS responsibilities will be reviewed in conjunction with other program principles Review sequence will remain unchanged

TxHmL Provider Certification Reviews
Reviews will monitor only provider services of individuals who receive CDS Compliance to §9.580(a)(21) will be reviewed in conjunction with other program principles Review sequence will remain unchanged

HCS Review Sample Individuals with CDS will be identified on pre-review report used by Waiver Survey and Certification (WS&C) One individual with CDS will always be included in the “comprehensive” review sample Additional individuals with CDS may be included in review sample depending on # of individuals with CDS, # of individuals served by contract, findings re: CDS in “comprehensive” review.

CDS-Related Principles in HCS
§9.175(b) - IDT may include CDSA representative §9.175(j)(1) - requires IDT to inform individual or LAR of right to transfer at least annually §9.175(j)(2) - requires IDT to document §9.175(j)(1)

§9.175(k) - for individuals receiving SHL or Respite, requires IDT to at least annually: (1) inform individual or LAR of right to participate or discontinue CDS at any time (2) provide individual or LAR Forms 1581, 1582 and 1583 which contain information re: CDS (3) provide oral explanation of information re: CDS (4) provide individual or LAR opportunity to choose CDS and document choice on Form 1584

§9.175(l) - If individual or LAR chooses CDS, requires IDT to: (1) provide names and contact info of all CDSAs in local service area (2) document individual’s or LAR’s choice of CDSA on Form 1584 (3) document description of service component to be provided through CDS in ISP (4) document individual’s service back-up plan in ISP

§9.175(m) - requires IDT to document: - that individual/LAR was informed of right to participate or discontinue CDS at any time and - that list of CDSAs was given to individual or LAR who chose to participate in CDS in ISP

§9.175(n) - requires IDT to recommend to DADS termination of FMS and support consultation for individuals in CDS if: (1) continued participation in CDS poses significant risk to individual’s health, safety, or welfare; (2) individual or LAR has not met Responsibilities of Employers and Designated Representatives section in Chapter 41, Subchapter B

§9.175(o) - if IDT recommends termination of FMS and Support Consultation, IDT must: (1) submit IPC to DADS electronically (2) submit following documentation to DADS Access & Intake: (A) description of service recommended for termination; (B) reasons termination is recommended; (C) descriptions of attempts to resolve issues; (D) any other supporting documentation

§9.177(b) - requires HCS providers adhere to each applicable rule or regulation

CDS Provider-Related Principles in TxHmL
§9.580(a)(21) - requires program provider to notify and document notification of individual’s Service Coordinator of individual’s or LAR’s expressed interest in CDS option

HCS and TxHmL Provider Review Sequence Will Remain Unchanged
Generally Prior Notification of Review Entrance Conference Home Visits Review of Documentation Periodic De-briefings Final De-briefing Exit Conference

CDS Implementation Training TxHmL Authority Principles
DADS Contract Accountability and Oversight (CAO) Monitoring and Oversight of Mental Retardation Authorities

Overview Identification of TxHmL Authority Principles Related to CDS
Identification of MRA and SC Responsibilities Key changes to CAO Oversight Process and identification of acceptable evidence for annual TxHmL Authority review 583 (b) 583 (r) 583 (s) (Presenter should introduce self)____________ with DADS Contract Accountability and Oversight Unit. The Contract, Accountability & Oversight Unit has the responsibility to review each MRA for compliance with the TxHmL Authority Principles. Beginning January 7, 2008, the Authority Principles related to Consumer Directed Services will become part of the annual compliance review with the implementation of CDS as a service delivery option with TxHmL. This presentation will focus only on the changes to oversight and monitoring of MRA compliance to TxHmL authority principles as it relates to CDS. It will: identify the TxHmL Authority Principles related to CDS identify the responsibilities of the MRA and of the Service Coordinators. identify changes to the review process, as well as identify supportive evidence, or documentation by which the CAO Review team will determine compliance with the Authority principles. 583 (t) 583 (v) 583 (u)

Oversight and Monitoring
Effective March 1, 2007, 40 TAC Chapter 9 includes new TxHmL authority principles specific to CDS Contract Accountability and Oversight Unit will continue to monitor MRA compliance with TxHmL Authority Principles through annual reviews. Review Process will include new principles beginning with implementation of CDS in Review sample will include, if applicable, CDS consumers. CAO will continue to conduct an annual on site review for compliance with the TxHmL Authority Principles through MRA staff interviews, and documentation review of a pre-selected sample of participants. Beginning January 2008, the process will include a review of compliance with the Authority Principles related to CDS. The sample of the participants chosen for the annual review will include consumers who self-direct all or some of their services. Also… Any participant chosen for the sample who was enrolled in TxHmL after January 2008 will have the documentation reviewed for MRA compliance with initial enrollment notification of CDS option.

Authority Principle Related to CDS
583 (b) 40 TAC §9.583 (b) Oversight Process Changes Process for Enrollment The Service Coordinator (SC) must include the following in the PDP: §9.567 (a) (6) – (8) The MRA must: §9.567 (b) (1) – (5) The first Authority Principle related to CDS §9.583 (b) references the process for enrollment into TxHmL Waiver Program. The CAO review team would reference this principle only for sample participants who were enrolled in TxHmL after January 7, 2008. This enrollment process (a) (6) through (8) specifies the SC responsibilities for the PDP requirements. And (b) (1) through (5) specifies the MRA responsibilities regarding notification.

Process for Enrollment Related to 40 TAC §9.583 (b)
Oversight Process Changes The SC must include in the PDP: §9.567 (a) (6) (6) a statement that the applicant was provided information regarding CDS as required by subsection (b) of this section. Acceptable Evidence: PDP documents the applicant or LAR was provided the required information regarding the CDS option. It must be documented in the enrollment PDP that the consumer or LAR was provided the required information regarding the CDS option. The specific required information is outlined in subsection (b) which will be covered in the next few slides.

Oversight Process Changes The SC must include in the PDP: §9.567 (a) (7) (7) if the applicant chooses to participate in CDS, a description of the service components provided through CDS, as required by subsection (e) of this section. Acceptable Evidence: All self-directed services must be included in the PDP. Read/Summarize Slide And… Once the CDS service delivery options have been presented to the enrollment applicant and the applicant chooses to participate, the SC must then include any and all self directed services in the PDP.

Oversight Process Changes The SC must include in the PDP: §9.567 (a) (8) (8) if the applicant chooses to participate in CDS, a description of the applicant’s service back- up plan, as required by subsection (e) of this section. Acceptable Evidence: The SC documents in the PDP a description of the applicant’s service back-up plan with required elements identified in subsection § (a) – (d). Read/Summarize Slide And… Any TxHmL enrollment PDP for a consumer who has chosen to self direct services should include the back up plan/s developed by the employer for all self directed services and are identified as critical to the health and welfare of the individual by the service planning team.

Oversight Process Changes The MRA must: §9.567 (b) (1) inform the applicant or LAR of the applicant’s right to participate in CDS and discontinue participation in CDS at any time, except as provided in 40 TAC § (a) of this title relating to Suspension of Participation in CDS; Acceptable Evidence: Documentation that the applicant or LAR was provided the required information of the applicant’s right to participate or discontinue participation in CDS. (Form 1584) All applicants to TxHmL waiver program should be informed of the right to participate in CDS at any time. The acceptable documentation to demonstrate compliance with this principle is Form 1584. (Note to team presenter: The exception noted which references (a) is related to a voluntary suspension from CDS option by the employer in which all program services are requested to be delivered by a program provider. )

Oversight Process Changes §9.567 (b) (2) (A) inform the applicant or LAR that: except as provided in subparagraph (B) of this paragraph, the applicant or LAR may choose to have one or more service components provided through CDS, the other service component must also be provided through CDS; Acceptable Evidence: Documentation that the applicant or LAR was informed of the service components provided through CDS and exceptions to the service components. Read/Summarize Slide And… There should be documentation that the applicant or LAR enrolling into the TxHmL waiver program was informed that one or more service components offered through TxHmL could be self directed. The exception to the service components and method of service delivery are regarding respite and community supports services.

Oversight Process Changes §9.567 (b) (2) (B) inform the applicant or LAR that: (B) if the applicant is receiving community support and respite and chooses to have one of these service components provided through CDS, the other service component must also be provided through CDS; Acceptable Evidence: Documentation that the applicant or LAR was informed of requirements related to choosing community support and respite service components provided through CDS. Read/Summarize Slide And… The expectation is that the documentation would demonstrate the applicant or LAR was informed of the specific requirements for Consumer Directed Services as it relates to respite and community support services.

Oversight Process Changes §9.567 (b) (3) (3) provide the applicant or LAR a copy of Forms 1581, 1582, and 1583 which are available at and which contain information about CDS, including a description of financial management services and support consultation; Acceptable Evidence: Documentation that the applicant or LAR was given a copy of Forms 1581 (CDS Option overview), 1582 (CDS Responsibilities & Self Assessment), and 1583 (Employee Qualification Requirements). Read/Summarize Slide And… The expectation from CAO for determination of compliance with this principle is documentation that copies of the Forms 1581, 1582 and 1583 are given to consumers upon enrollment into Texas Home Living waiver program.

Oversight Process Changes §9.567 (b) (4) (4) provide an oral explanation of the information contained in Forms 1581, 1582, and 1583 to the applicant or LAR; and Acceptable Evidence: Documentation from the individual’s record that the applicant or LAR was given an oral explanation of the information contained in Forms 1581, 1582, 1583 and 1584. Read/Summarize Slide And… The expectation from CAO for determination of compliance with this principle is documentation of an oral explanation of the information contained in Forms 1581, 1582, 1583 and 1584 are given to consumers upon enrollment into Texas Home Living waiver program

Oversight Process Changes §9.567 (b) (5) (5) provide the applicant or LAR the opportunity to choose to participate in CDS and document the applicant’s or LAR’s choice on Form 1584, which is available at Acceptable Evidence: Individual or LAR choice documented on Form 1584 Read/Summarize Slide

Oversight Process Changes §9.583 (h) (1) An MRA must maintain for each individual: (1) a current IPC Acceptable Evidence: New IPC (Form 8582) for all individuals Read/Summarize Slide And… After January 7, 2008, for initial enrollments into TxHmL the new IPC (Form 8582) will need to be completed by the MRA. The new IPC form should be completed by the MRA for individuals currently enrolled into TxHmL as annual plan dates are due following January 7, 2008.

Oversight Process Changes §9.583 (k) (1) An MRA must ensure that a service coordinator: (1) Initiates, coordinates and facilitates the PDP Planning process to meet the desires and needs as identified by an individual and LAR in the individual’s PDP. Acceptable Evidence: PDP should address the individual’s desires and needs including evidence as to whether CDS option was desired or chosen. Read/Summarize Slide And… CAO review team would expect documentation to show: (1) …for a sample participant who has chosen not to self direct any services, the expectation is that documentation would demonstrate that CDS was explored as part of the person/family directed planning process with the consumer or LAR. (2)… for a sample participant who has chosen to self direct, the expectation is that evidence would demonstrate that the choice was directed by the sample participant or LAR.

Oversight Process Changes §9.583 (k) (4) An MRA must ensure that a service coordinator: (4) Coordinates and develops an individual’s IPC based on the individual’s PDP Acceptable Evidence: New IPC (Form 8582) Read/Summarize Slide And… As a reminder on the expectation for the use of the new IPC… After January 7, 2008, the new IPC should be used at the renewal of the annual IPC.

Oversight Process Changes §9.583 (k) (5) An MRA must ensure that a service coordinator: (5) coordinates and monitors the delivery of TxHmL and non-TxHmL Program services. Acceptable Evidence: If applicable, documentation concerning SC requesting either employer CAP per § (a)-(d) or CDSA transfer per requirements outlined in § (c) (1) – (4). Read/Summarize Slide And… For sample participants who have chosen to self direct, the expectation for acceptable evidence regarding coordination and monitoring remains the same as the current expectations for compliance with this principle. With CDS it now may include, as applicable: Documentation that the SC requested a CAP from the employer or DR. This could be an expectation as determined by CAO through a review of SC progress notes. Documentation that the SC processed the employer’s request to transfer CDSA. 1) SC calculated the units needed to complete the plan year 2) SC revised the service plan 3) Provided copies of the service plan to employer and both receiving and transferring CDSAs.

Oversight Process Changes The Service Coordinator must: §9.583 (m) (6) (6) ensure that the individual or LAR is informed of decisions regarding denial or termination of services and the individual’s or LAR’s right to request a fair hearing as described in §9.571 of this subchapter (relating to Fair Hearings); Acceptable Evidence: Documentation that the SC orally explained the requirements identified in § (b) and (c) concerning denials or terminations. Read/Summarize Slide

Oversight Process Changes The Service Coordinator must, at least annually §9.583 (r) (1) – (4) (1) inform the individual or LAR of the individual’s right to participate in CDS and discontinue participation in CDS at any time, except as provided in 40 TAC § (a) of this title (relating to Suspension of Participation in CDS); Acceptable Evidence: Documentation that the SC reviewed CDS participation rights at least annually. Read/Summarize Slide And… This principle is applicable to sample participants previously enrolled in TxHmL and would not be applicable to those persons who are initially enrolled during the MRA review period. The expectation is for these notifications (1 through 4) to occur as part of the annual plan meeting for all TxHmL consumers regardless of their status with CDS. MRA should document the annual review of CDS options. 583 (r)

Oversight Process Changes §9.583 (r) (2) provide the individual or LAR a copy of Forms 1581, 1582, and 1583 which are available at and which contain information about CDS, including a description of financial management services and support consultation Acceptable Evidence: Documentation that a copy of Forms 1581, 1582, and 1583 were provided to individual or LAR . Read/Summarize Slide And… Documentation should demonstrate that the individual or LAR received copies of Forms 1581, 1582, 1583.

Oversight Process Changes §9.583 (r) (3) (3) provide an oral explanation of the information contained in Forms 1581, 1582, and 1583 to the individual or LAR; and Acceptable Evidence: Documentation that Forms 1581, 1582 and 1583 were explained orally. Read/Summarize Slide And… To demonstrate compliance with this principle, the MRA documentation should indicate that an oral explanation of the information in these forms was provided.

Oversight Process Changes §9.583(r) (4) (4) provide the individual or LAR the opportunity to choose to participate in CDS and document the individual’s choice on Form 1584, which is available at Acceptable Evidence: Documentation of individual or LAR choice on Form 1584. Read/Summarize Slide

Oversight Process Changes The Service Coordinator must (if individual or LAR chooses CDS): §9.583 (s) (1) – (4) provide names and contact information to the individual or LAR regarding all CDSAs providing services in the MRA’s local service area; Acceptable Evidence: Documentation that the SC provided names and contact information to the individual or LAR regarding all CDSAs providing services in the MRA’s local service area. Read/Summarize Slide 583 (s)

Oversight Process Changes §9.583 (s) (2) document the individual’s or LAR’s choice of CDSA on Form 1584; Acceptable Evidence: Form 1584 Read/Summarize Slide

Oversight Process Changes §9.583 (s) (3) (3) document, in the individual’s PDP, a description of the service components provided through CDS; and Acceptable Evidence: Documentation in the Annual/Revised PDP describing the service components that will be provided through CDS. Read/Summarize Slide And… As the consumer has chosen to participate in Consumer Directed Services, the SC must then include any and all self directed services in the PDP. This would be applicable to an annual PDP at which time the consumer was presented options, chose CDS and the components would be included in the annual plan. It could also occur during any time during the plan year if the consumer requested information about CDS and chose to self direct. The components would be included in a revised PDP.

Oversight Process Changes §9.583 (s) (4) (4) document, in the individual’s PDP, a description of the individual’s service back-up plan. Acceptable Evidence: Documentation in the Annual/Revised PDP that describe the individual’s service back-up plan (Form 1740). Elements of a service back-up plan are defined in the CDS rule: 40 TAC § (27) and § (a)-(d). Read/Summarize Slide And… A PDP for an individual, who has chosen to self direct services, should include the back up plan/s developed by the employer. This plan must include all self directed services that have been identified to be critical to the health and welfare of the individual.

Oversight Process Changes §9.583 (t) (t) document in the individuals PDP that the information described in subsections (r) and (s) (1) of this section was provided to the individual or LAR. Acceptable Evidence: Documentation in the annual PDP that the SC shared CDS information detailed in (r) and (s)(1) with the individual or LAR. Read/Summarize Slide Whether or not an individual has opted to participate in CDS the MRA needs to document the individual’s choice as it relates to §9.583 (r) and § (s)(1) 583 (t)

Oversight Process Changes §9.583 (u) (1) (2) For an individual participating in CDS, the MRA must recommend to DADS that financial management services and support consultation, if applicable, be terminated if the service coordinator determines that: (1) the individual’s continued participation in CDS poses a significant risk to the individual’s health, safety or welfare; or Acceptable Evidence: If applicable, documentation must demonstrate that the MRA recommended to DADS termination of these services if, SC determined that (u)(1) and/or (u)(2). Read/Summarize Slide 583 (u)

Oversight Process Changes §9.583 (u) (2) (2) the individual or LAR has not complied with Chapter 41, Subchapter B of this title (relating to Responsibilities of Employers and Designated Representatives). Acceptable Evidence: If the MRA recommends termination of CDS services based on (u) (1) or (2), acceptable documentation may include the SC, DADS, or CDSA requesting a Corrective Action Plan per § (a)-(d) . Read/Summarize Slide

Oversight Process Changes §9.583 (v) (1) (2) If an MRA makes a recommendation under subsection (u) of this section, the MRA must: (1) submit the individual’s IPC to DADS electronically ; and Acceptable Evidence: Documentation reflecting electronic submission of individual’s revised IPC to DADS Read/Summarize Slide 583 (v)

Oversight Process Changes §9.583 (v) (2) (A)-(D) (2) submit the following, in writing, to the Department of Aging and Disability Services, Access and Intake, Program Enrollment, Utilization Review, P..O. Box , Mail Code W-354, Austin, Texas Acceptable Evidence: Documentation describing (v) (2) (A)-(D) was submitted in writing to DADS Read/Summarize Slide

Oversight Process Changes §9.583 (v) (2) (A)-(D) a description of the service recommendation for termination; the reasons why termination is recommended; a description of the attempts to resolve the issues before recommending termination; and Other supporting documentation, as appropriate. Acceptable Evidence: Documentation describing (v) (2) (A)-(D) was submitted in writing to DADS Read/Summarize Slide

Summary Identification of TxHmL Authority Principles Related to CDS
Identification of MRA and SC Responsibilities Key changes to the CAO Process and identification of acceptable evidence for annual TxHmL Authority review 583 (r) 583 (b) 583 (s) 583 (t) 583 (u) 583 (v)

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Consumer Directed Services (CDS) Implementation Training for the Home and Community-based Services (HCS) and the Texas Home Living (TxHmL) Programs.

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Consumer Directed Services (CDS) Implementation Training for the Home and Community-based Services (HCS) and the Texas Home Living (TxHmL) Programs.

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Presentation on theme: "Consumer Directed Services (CDS) Implementation Training for the Home and Community-based Services (HCS) and the Texas Home Living (TxHmL) Programs."— Presentation transcript:

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